[Myositis ossificans progressiva; review and case report].
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Soft tissue ossification is a well-known phenomenon in various pathologic conditions. Myositis ossificans circumscripta refers to posttraumatic calcification of soft tissue, including various ligaments. However, posttraumatic calcification of ligaments in the pelvis is a rare complication described only anecdotally in the past. We present a rare case of posttraumatic calcification of the sacrotuberous ligament in a patient, several months after suffering a pelvic trauma. This is one of the differential diagnoses of soft tissue pain and tenderness after trauma.
A case of clear-cell chondrosarcoma occurred in the proximal femur of a 32-year-old man. The tumor was complicated by a focus of myositis ossificans resulting from a previous intralesional biopsy. Histologic findings included an unusual marrow infiltration by the tumor. The patient was treated with wide resection and has no evidence of local recurrence or distant spread of disease 18 months later.
We describe a case of calcifying haematoma in a 78-year-old war veteran with a mass in his right lower leg. The likely differential diagnosis of myositis ossificans and soft tissue sarcoma was worked up. We discuss some of the difficulties of diagnosis despite having computed tomography and magnetic resonance imaging examinations and the unexpected final diagnosis of calcifying haematoma that was made on incisional biopsy.
We describe a child who was treated for 10 years with etidronate disodium for myositis ossificans. There were no typical bouts of swelling, reddening or hardening of areas over the skeletal muscles with this treatment and there were no side effects. Nevertheless, a constant gradual progression of the disease led to severe limitation of joint movement. This is the first report on long-term treatment with etidronate disodium.
A 20-year-old woman with a severely crippling myositis ossificans progressiva was treated with a diphosphonate (EHDP), 10-20 mg/kg/day. While being treated with this drug, surgical removal of ectopic bone was performed. Although ectopic calcification recurred postoperatively, considerable functional improvement was achieved. At the highest dosage of EHDP, hypercalcaemia gradually appeared, but was reversible upon cessation of drug treatment. It is probably related to a direct effect of EHDP on the bone.
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One muscle trauma is a common injury in contact sports. The most extensively damaged muscle is that segment closest to the underlying bone. By an unknown mechanism, this injured muscle can become transformed into heterotopic bone, a complication also called myositis ossificans. It is best managed conservately and rarely requires surgery.
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The effect of warfarin sodium on excretion of calcium, phosphorus, and 4-carboxy-L-glutamic acid (Gla) was studied in 5 patients with ectopic calcification (2 with scleroderma, 1 with dermatomyositis, and 2 with myositis ossificans progressiva). Warfarin reduced urinary excretion of Gla in all patients, but no changes in calcium and phosphorus excretion or in objective parameters of calcinosis were observed during 6-36 months of treatment. Two patients experienced hemorrhagic complications during therapy, emphasizing a hazard of long-term anticoagulation treatment. Since ectopic calcium deposits contain Gla-rich protein, suppression of Gla synthesis by warfarin sodium over a longer period may prevent deposition and allow removal of existing calcinosis deposits.
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