Images in Clinical Rheumatology
Myositis Ossificans in Elbow Mimicking Soft Tissue Sarcoma: Similar Clinical and Radiological Findings
Miositis osificante circunscrita en codo simulando un sarcoma de partes blandas: hallazgos clínico-radiológicos similares
Elena Espinosa Muñoz
, Diego Ramírez Ocaña, Ana María Martín García, Carmen Puentes Zarzuela
Corresponding author
Unidad de Gestión Clínica de Medicina Nuclear, Hospital Regional Universitario de Málaga, Málaga, Spain
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She referred to a previous history of trauma, and had been diagnosed with fibrillar muscle rupture. Due to the persistence of symptoms, an out-patient MRI was performed which resulted in suspicion of soft tissue sarcoma and the patient was admitted to hospital for further study. Laboratory tests and a CT scan of the chest and abdomen were negative. A two phase bone scan (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B), showed a heterogeneous uptake area in the anterior region of the left elbow with no relevant findings at any other level. Differential diagnosis was suggested as sarcoma of the soft tissue, chondrosarcoma and osteochondroma with malignant degeneration. It was finally decided that ultrasound-guided percutaneous biopsy be performed, the result of which was mesenchymal tumour without signs of malignancy and final diagnosis of myositis ossificans was made. Rest, anti-inflammatory treatment and physiotherapy were recommended as treatment. Three months later the patient showed clinical signs of improvement and a reduction in pain, with complete flexion and extension at 120°. Plain radiological control (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A and B) and noncontrast CT imaging (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) revealed a calcified mass, compatible with the anatomopathological diagnosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Didactic Message</span><p id="par0010" class="elsevierStylePara elsevierViewall">Confined myositis ossificans is a rare entity of uncertain aetiopathogenesis, characterised by a cellular metaplasia of connective tissue induced by trauma.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1–3</span></a> Examination highlights a hardened tumour which is indistinguishable from other tumour lesions.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> Its main problem arises from generally being confused with malignant (and particularly soft tissue sarcoma) and infectious (osteomyelitis) processes.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1,2</span></a> It is important to be familiar with the morphological–functional characteristics of this lesion, which evolve at different stages, the acute phase producing an inflammatory reaction with a clinical and radiological pattern that is difficult to distinguish from aggressive conditions.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> The creation of an exhaustive medical history is essential (possible trauma, repeated aggressions, burns, prolonged immobilisation, traumatic paralysis) and an anatomopathologic study to rule out myositis ossificans which is a benign pathology treated in a conservative manner.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1–4</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authorship</span><p id="par0015" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0020" class="elsevierStylePara elsevierViewall">Manuscript conception and design: Elena Espinosa Muñoz.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0025" class="elsevierStylePara elsevierViewall">Data collection: Elena Espinosa Muñoz.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0030" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: Elena Espinosa Muñoz, Diego Ramírez Ocaña, Ana María Martín García and Carmen Puentes Zarzuela.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0035" class="elsevierStylePara elsevierViewall">Manuscript redaction, review, and approval: Elena Espinosa Muñoz, Diego Ramírez Ocaña, Ana María Martín García and Carmen Puentes Zarzuela.</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Ethical Liabilities</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Protection of people and animals</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that for this research no experimentation has been carried out on human beings or animals.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Data confidentiality</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Right to privacy and informed consent</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflict of Interests</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Didactic Message" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authorship" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "Ethical Liabilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Right to privacy and informed consent" ] ] ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of Interests" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-11" "fechaAceptado" => "2017-05-17" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Espinosa Muñoz E, Ramírez Ocaña D, Martín García AM, Puentes Zarzuela C. Miositis osificante circunscrita en codo simulando un sarcoma de partes blandas: hallazgos clínico-radiológicos similares. Reumatol Clin. 2019;15:e57–e59.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2617 "Ancho" => 2083 "Tamanyo" => 135542 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Two phase bone scan after the injection of 814<span class="elsevierStyleHsp" style=""></span>MBq of <span class="elsevierStyleSup">99m</span>Tc-hydroxy-biphosphonate. Static images after 10<span class="elsevierStyleHsp" style=""></span>min (tissue phase [A]) and total body after 2<span class="elsevierStyleHsp" style=""></span>h (bone phase [B]), where heterogeneous uptake may be observed of the radiotracer in anterior region of the left elbow (arrows).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1394 "Ancho" => 2083 "Tamanyo" => 199058 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Plain X-ray of left elbow in lateral projection (A) and anteroposterior (B) projection.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 478 "Ancho" => 900 "Tamanyo" => 16590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Noncontrast iv CT image of the left elbow. Both radiology studies show a calcified mass with a sclerotic surface not dependent upon on the radial cortex (arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miositis osificante aguda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Ríos Zambudio" 1 => "J. Illana Moreno" 2 => "A. Piñero Madrona" 3 => "A. Parrilla Paricio" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s0014-2565(01)70844-2" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp" "fecha" => "2001" "volumen" => "201" "paginaInicial" => "349" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11490917" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miositis osificante: evaluación mediante RM" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Dosdá" 1 => "L. Martí-Bonmatí" 2 => "J. Galant" 3 => "L. 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Iriarte-Ortabe" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Esp Cir Oral Maxilofac" "fecha" => "2013" "volumen" => "35" "paginaInicial" => "137" "paginaFinal" => "143" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Miositis osificante en los músculos del cuello" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Pàmies" 1 => "A. Samitier" 2 => "J. Rodríguez-Fernández" 3 => "R. Fontova" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.reuma.2014.08.004" "Revista" => array:6 [ "tituloSerie" => "Reumatol Clin" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "182" "paginaFinal" => "183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25488113" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000001500000005/v1_201910260908/S2173574318301217/v1_201910260908/en/main.assets" "Apartado" => array:4 [ "identificador" => "5795" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in Clinical Rheumatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000001500000005/v1_201910260908/S2173574318301217/v1_201910260908/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574318301217?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 2 | 5 |
| 2024 October | 66 | 34 | 100 |
| 2024 September | 87 | 31 | 118 |
| 2024 August | 86 | 39 | 125 |
| 2024 July | 91 | 27 | 118 |
| 2024 June | 64 | 33 | 97 |
| 2024 May | 83 | 27 | 110 |
| 2024 April | 87 | 23 | 110 |
| 2024 March | 84 | 26 | 110 |
| 2024 February | 119 | 25 | 144 |
| 2024 January | 114 | 23 | 137 |
| 2023 December | 93 | 22 | 115 |
| 2023 November | 167 | 31 | 198 |
| 2023 October | 154 | 26 | 180 |
| 2023 September | 151 | 36 | 187 |
| 2023 August | 133 | 11 | 144 |
| 2023 July | 99 | 30 | 129 |
| 2023 June | 89 | 22 | 111 |
| 2023 May | 86 | 20 | 106 |
| 2023 April | 69 | 13 | 82 |
| 2023 March | 112 | 19 | 131 |
| 2023 February | 130 | 17 | 147 |
| 2023 January | 107 | 12 | 119 |
| 2022 December | 119 | 38 | 157 |
| 2022 November | 127 | 23 | 150 |
| 2022 October | 108 | 27 | 135 |
| 2022 September | 131 | 33 | 164 |
| 2022 August | 88 | 37 | 125 |
| 2022 July | 87 | 38 | 125 |
| 2022 June | 101 | 32 | 133 |
| 2022 May | 94 | 36 | 130 |
| 2022 April | 86 | 41 | 127 |
| 2022 March | 115 | 46 | 161 |
| 2022 February | 145 | 28 | 173 |
| 2022 January | 182 | 33 | 215 |
| 2021 December | 93 | 46 | 139 |
| 2021 November | 83 | 37 | 120 |
| 2021 October | 110 | 63 | 173 |
| 2021 September | 99 | 44 | 143 |
| 2021 August | 89 | 38 | 127 |
| 2021 July | 139 | 29 | 168 |
| 2021 June | 96 | 31 | 127 |
| 2021 May | 92 | 45 | 137 |
| 2021 April | 232 | 92 | 324 |
| 2021 March | 142 | 38 | 180 |
| 2021 February | 124 | 18 | 142 |
| 2021 January | 95 | 22 | 117 |
| 2020 December | 63 | 20 | 83 |
| 2020 November | 70 | 17 | 87 |
| 2020 October | 48 | 22 | 70 |
| 2020 September | 57 | 27 | 84 |
| 2020 August | 42 | 18 | 60 |
| 2020 July | 30 | 21 | 51 |
| 2020 June | 59 | 12 | 71 |
| 2020 May | 35 | 18 | 53 |
| 2020 April | 17 | 10 | 27 |
| 2020 March | 26 | 1 | 27 |
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