Medicine, Northern Hospital Epping, Epping, Victoria, Australia
Surgery, Austin Health, Heidelberg, Victoria, Australia.
BMJ Case Rep. 2022 Mar 30;15(3):e245478. doi: 10.1136/bcr-2021-245478.
Rhabdomyolysis is characterised by skeletal muscle breakdown, with release of toxic intracellular contents into the circulation. A man in his 20s presented to the emergency department with acute-onset right arm swelling, with pitting oedema extending into his forearm without clear precipitant. Initial differential diagnosis was upper extremity deep vein thrombosis, however none was identified on CT venogram. Instead, rhabdomyolysis of long head of triceps was diagnosed after multidisciplinary review of the venogram by the treating vascular surgeon and radiologist. Retrospectively, added serum creatine kinase was found to be 11 587 U/L, and together with MRI of the right arm, the diagnosis was established. Given the patient's lack of comorbidities, normal renal function and reliability, he was managed conservatively as an outpatient without hospital admission for intravenous hydration. This is the only case to our knowledge of isolated long head of triceps' rhabdomyolysis reported in Australia and the second case worldwide.
横纹肌溶解症的特征是骨骼肌破裂,有毒的细胞内物质释放到血液循环中。一名 20 多岁的男性因急性右臂肿胀就诊于急诊科,凹陷性水肿延伸至前臂,但无明确的诱因。最初的鉴别诊断为上肢深静脉血栓形成,但 CT 静脉造影未发现血栓。相反,经过血管外科医生和放射科医生对静脉造影的多学科审查,诊断为三头肌长头横纹肌溶解症。回顾性检查发现,血清肌酸激酶升高至 11587U/L,结合右臂 MRI,确诊为该病。鉴于患者无合并症、肾功能正常且可靠,他被作为门诊患者进行保守治疗,无需住院静脉补液。据我们所知,这是澳大利亚首例孤立性三头肌长头横纹肌溶解症病例,也是全球第二例。