Age / Sex : 62 / M

Age / Sex : 62 / Male

Chief complaint : Back pain after prostatectomy

                 Prostate cancer

Discussion

Findings:

▪ Enhanced CT scan shows swollen bilateral paraspinal muscles with heterogeneous enhancement.

▪ Axial T1WI shows swollen bilateral erector spinae muscles with intermediate to high signal intensity.

▪ Axial and sagittal T2WI shows heterogenous high signal intense lesion in the bilateral erector spinae muscles.

▪ Gadolinium enhanced axial T1WI shows heterogenous enhancement in the bilateral erector spinae muscles.

Diagnosis:  

Lumbar paraspinal rhabdomyolysis

Discussion:

Rhabdomyolysis is a skeletal muscle disease with release of muscle cell contents into the extracellular fluid and plasma. The cause may be a mechanical trauma or muscular compression, excessive muscular activity, ischemic or thermal muscle injury, various metabolic disorders, drug overdose, polymyositis, infection, or of idiopathic origin.

Lumbar paraspinal rhabdomyolysis and compartment syndrome is an uncommon disorder that has been shown to arise after strainful exercise or trauma.

The risk factors that have been often proposed to contribute to the development of rhabdomyolysis: male sex, elevated BMI, prolonged OR time, and procedure performed with the patient in the lateral decubitus or 45-degree lateral decubitus position.

Clinical presentation is characterized by lower back pain of sudden onset with tenderness, swelling, and rigidity of paravertebral muscles, limiting spine motion. Elevation of serum enzymes, including creatine phosphokinase, lactic dehydrogenase, and transaminases, and renal dysfunction with myoglobinuria are often present.

The MRI features of rhabdomyolysis are nonspecific, but in the case of an established clinical and laboratory diagnosis, MRI is highly effecti Rhabdomyolysis shows high signal intensity of the swollen muscles on T1- and T2-weighted imaging. To show the extent of the disease in the acute state and the recovery during follow-up, MRI is a highly accurate tool.ve in localizing rhabdomyolysis.

Treatment of rhabdomyolysis consists of bed rest, analgesics, and intravenous hydration of the patient with careful control of electrolytes.

References:

1. Ferreira J, Galle C, Aminian A, Michel P, Guyot S, Wilde JP, et al. Lumbar paraspinal rhabdomyolysis and compartment syndrome after abdominal aortic aneurysmrepair. J Vasc Surg 2003;37:198-201

2. Glassman DT, Merriam WG, Trabulsi EJ, Byrne D, Gomella L. Rhabdomyolysis after laparoscopic nephrectomy. JSLS 2007;11:432-437

3. Stock KW, Helwig A. MRI of acute exertional rhabdomyolysis in the paraspinal compartment syndrome. J Comput Assist Tomogr 1996;20:834-836