case_images: PMC6637392_01
case_images: Coronal T1-weighted (A & C) and T1-weighted fat-suppression technique known as short tau inversion recovery (STIR)* (B & D) MR images of the thighs and upper leg reveal subcutaneous, fascial, and intramuscular edema and muscle enlargement, findings that are most pronounced in the anterior and medial muscle compartments of the left thigh (B = white arrow). The abnormal signal seen in the subcutaneous tissues of the thigh extends into the gluteal region. There, abnormality extends down to the visualized knee joint with subcutaneous edema of the upper calf (D = white arrow head). The asymmetric distribution of the findings and the involvement of noncontiguous muscles are characteristic of this condition. *In inversion-recovery imaging, suppression of the fat signal is based on differences in the T1 of the tissues. The T1 signal of adipose tissue is shorter than the T1 signal of water. By use of a pulse at a specific point during T1 imaging, known as the null point of adipose tissue, the adipose tissue will produce no signal whereas water still will. Therefore, the fat signal can be suppressed by using a STIR sequence.
case_images: CNCS-7-041-01.jpg
case_images: PMC6637392_01_CNCS-7-041-01.jpg
case_images: Figure1
case_images: T1-weighted imaging (Figure 1). This, in conjunction with fat suppression through short tau inversion recovery (STIR), was reflective of an inflammatory or infective process.
case_images: PMC6637392_02
case_images: Coronal T1-weighted (A & C) and T1-weighted fat-suppression technique known as short tau inversion recovery (STIR) (B & D) MR images of the knee and upper leg reveal perifascial, and intramuscular edema within the left calf muscle, interestingly sparing the medial head of the gastrocnemius (D = white arrow). There is increased signal intensity from the lateral head of the gastrocnemius and lateral compartmental muscles of the lower leg (B & D). The asymmetric distribution of the findings and the involvement of noncontiguous muscles are characteristic of this condition.
case_images: CNCS-7-041-02.jpg
case_images: PMC6637392_02_CNCS-7-041-02.jpg
case_images: Figure2
case_images: MRI (Figure 2). Muscle biopsy was again avoided, and the patient was treated with morphine sulphate 20 mg in the morning and 30 mg in the evening, with 2.5 mg oramorph for break through pain, and gentle physiotherapy.