Weekly Case

Title : Case 660

Age / Sex : 13 / M


Chief complaint :


 Rt. Thigh pain, due to trauma


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).


Courtesy : 김선기 (Sun Ki Kim), 가톨릭대학교 인천성모병원 (Incheon St. Mary’s Hospital, The Catholic University of Korea)


Diagnosis:

Intramuscular Degloving Injury of the Rectus Femoris



Discussion


Findings:


MRI  :



  1. Rupture in the indirect (central) tendon of rectus femoris muscle, with surrounding fluid.

  2. Proximal retraction in the indirect head of the rectus femoris muscle.


 


Differential Diagnosis:


Sof tissue tumor, inflammation, ganglion


  


Discussion:


Rectus femoris muscle - consists of two heads.


 


1) direct (straight) head  (arise from anterior inferior iliac spine of the ilium)


--> unipennate muscle and blends with the anterior fascia.


 


2) indirect (reflected) head  (arise from superior acetabular ridge and hip capsule)


--> the deep, central intramuscular tendon (bipennate muscle), which is enveloped by unipennate muscle.


( outer unipennate muscle surrounds an inner bipennate muscle à muscle-within-muscle configuration )





  • Intramuscular degloving injury of the rectus femoris –


separation of the central indirect tendon (inner bipennate component) from the outer (surrounding unipennate component) rectus femoris muscle à this appearance is similar with a finger in a glove à therefore, it is called intramuscular degloving injury


 


  References:


 1. Kassarjian A, Rodrigo RM, Santisteban JM. Intramuscular degloving injuries to the rectus femoris: findings at MRI. AJR Am J Roentgenol 2014;202(5):W475–W480.


 2. Mariluisa CA, Cupitob J, Mamone F. Muscle injuries of the rectus femoris muscle. MR update. Rev Argent Radiol. 2015;79(4):182–91.


 3. Gyftopoulos S. Rosenberg ZS, Schweitzer ME, Bordalo-Rodrigues M. Normal anatomy and strains of the deep musculotendinous junction of the proximal rectus femoris: MRI features. AJR 2008; 190:[web]W182–W186



Correct Answer
Total applicants 23 Correct answers 16
Name Institution
여현정 전문의
강지희 서울대학교병원, 전문의
조영민 전문의
윤유성 순천향대 부천병원, 전문의
한유비 전문의
김동언 국군양주병원, 전문의
최형인 군의관, 전문의
김기욱 국군수도병원, 전문의
전인환 전문의
김유진 전문의
백승진 분당차병원, 전공의
김성진 365병원, 전문의
김혜정 강북삼성병원, 전공의
김형민 전문의
김동수 전공의
김현진 전공의
Semi-Correct Answer
Total applicants 23 Semi-Correct answers 5
이규정 고대안암병원, 전문의
변성환 전공의
김다정 전문의
김지은 서울대학교병원, 전문의
유해원 전공의


Comment