|Title : Case 658|
Age / Sex : 46 / M
Chief complaint: left flank pain developed 10 days ago
Side strain (internal oblique muscle tear)
additional Hx: Start taking table tennis lessons from a few months ago
Initial CT showed a peripherally enhancing low attenuation mass in the left-sided internal oblique muscle. Mass increased on F/U CT and subsequently decreased which was demonstrated by MR images (not shown). US exam for biopsy was requested but biopsy not performed because US findings were more likely to be muscle strain rather than neoplastic conditions. Last F/U US well demonstrated healing process of the muscle strain.
Activities associated with cricket, javelin throwing, rowing, ice hockey, and tennis.
Commonly occurs at rib or costal cartilage insertion site.
Superficial anterolateral abdominal muscle & Located beneath external oblique muscle.
Insertion: linea alba, pectineal line of pubis (via conjoint tendon), ribs 10-12th.
Accessory muscle of respiration, antagonist to diaphragm.
Sudden eccentric contracture cause rupture.
Activities associated with lengthening of muscle (In hyperextended position).
Sudden vigorous motion of contraction or pull thorough.
Acute tear: edema/hemorrhage or hematoma tracking between myofascial coverings of internal & oblique muscles.
Stripping of periosteum from undersurface of rib.
At F/U, gap created by detachment of muscle fibers filled with fibrosis and scar tissue which could be appeared as hypertrophied mass.
Take home message
In severe lateral abdominal pain following trunk rotation, tear of abdominal oblique muscles could be considered as a differential diagnosis.
|Total applicants||22||Correct answers||4|