TUBERCULOSIS of CALF MUSCLE, Dr PHAN THANH HẢI

A 37YO WOMAN BY HERSELF DETECTED A LUMP AT HER LEFT CALF FOR ONE MONTH, NO PAIN NOR FEVER.

IN CLINICAL EXAMINATION THIS  FIRM MASS WAS 10CM IN SIZE, ELLIPTICAL SHAPE AND BELONGED TO THE LEFT GASTROCNEMIUS MUSCLE.

SMALL PART ULTRASOUND=

IT WAS A HYPOECHOIC INTRAMUSCULAR MASS, WELL BORDERED WITH MORE POSTERIOR ENHANCEMENT (IMAGE 1).

IN CROSS-SECTION, THE MASS HAD NO LACK OF DEFINITION OF  MUSCLE ARCHITECTURE, BUT SOME AREAS CHANGED TO HYPOECHOIC PATTERN LOOK LIKE FLUID (IMAGE 2).

IMAGE 3 : IN COLOR DOPPLER, THE MASS HAD HYPERVASCULAR PATTERN WHICH WAS SUPPLIED FROM OUTSIDE.

IMAGE 4: SPECTRAL PULSE WAVE PATTERN WITH LOW RI VALUE= 0,5.

IMAGE 5: B MODE SUPERSONIC WAS A HYPOECHOIC MASS.

IMAGE 6:  QUANTITATIVE ELASTOGRAPHY SHOWED LOW ELASTIC SCORE #30kPa  (EQUIVALENT ELASTOGRAPHIC VELOCITY = 3cm/sec) IN COMPARISON TO SURROUNDING MUSCLE.

BIOPSY WAS DONE WITH SUSGESTION OF AN INFLAMATION MASS AS MYOSITIS FOCAL LESION.

HISTOPATHOLOGIC RESULTS= SOME TUBERCULAR VESICLES OF MUSCLE AND SOFT TISSUES  INCLUDED CASEUM IN THE CENTRAL  AND SURROUNDING WITH DEGENERATIVE CELLS, LYMPHOCYTES AND LANGHANS GIANT CELLS.
CONCLUSIONS= A TUBERCULAR MYOSITIS.

SO THE PRESENT CASE ILLUSTRATES A TUBERCULOSIS OF SOLEUS MUSCLE WHICH INCLUDES THE  HISTOLOGIC RESULT AND SOME INTERESTING ULTRASOUND FINDINGS, ESPECIALLY THE SHEARWAVE ELASTOGRAPHY CHARACTERS.

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