technetium-tc-99m-pyrophosphate and Myositis-Ossificans

Functionally disabling myositis ossificans of the posterior aspect of the elbow occurred in a 66-year-old man as a sequela of tetanus. Serial quantitative bone scans were done to determine the optimal time for excision, which produced an excellent functional result without recurrence at 4 years.

Topics: Aged; Elbow Joint; Humans; Male; Myositis Ossificans; Ossification, Heterotopic; Radionuclide Imaging; Technetium Tc 99m Pyrophosphate; Tetanus

Although most physicians associated myositis ossificans with recent, acute trauma, only 40%-60% of patients give such a history. The appearance of a soft tissue mass without a clear history of trauma may suggest a diagnosis of sarcoma, especially because results of a biopsy of the central portion of an area of myositis ossificans may yield immature, undifferentiated tissue resembling a sarcoma. Pain and rapid growth of a mass are more usual in myositis ossificans than in sarcomas, and careful inquiry may reveal stretching injury or chronic trauma associated with normal, vigorous, physical activities. Recognizing the characteristic histologic zoning phenomenon (immature tissue centrally surrounded by more mature tissue and a peripheral shell of benign bone) during the biopsy procedure permits the correct diagnosis of myositis ossificans. Plain radiographs or conventional tomograms may reflect this histologic zoning by demonstrating the typical, mature, outer shell of bone. Although additional radiographic studies are not usually necessary, they may be obtained when the mass is suspected to be a sarcoma. In two patients computed tomographic scans clearly demonstrated well-defined, peripheral shells of mature bone, diagnostic of myositis ossificans.

Topics: Adolescent; Adult; Diphosphates; Female; Humans; Male; Myositis Ossificans; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, X-Ray; Tomography, X-Ray Computed