page_title: Diabetic myonecrosis
section_title: Investigations and diagnosis
hierarchical_section_title: Diabetic myonecrosis / Investigations and diagnosis
caption_attribution_description: English: Axial fat suppressed post gadolinium contrast enhancment MRI image showing absent enhancement in the left thigh adductor muscles centrally indicating necrosis in diabetic myonecrosis.
context_page_description: Diabetic myonecrosis is a complication of diabetes. It is caused by infarcted muscle tissue, usually in the thigh.
context_section_description: Tissue biopsy is the gold standard.  Macroscopically this reveals pale muscle tissue.  Microscopically infarcted patches of myocytes.  Necrotic muscle fibers are swollen and eosinophilic and lack striations and nuclei.  Small-vessel walls are thickened and hyalinized, with luminal narrowing or complete occlusion.  Biopsy cultures for bacteria, fungi, acid-fast bacilli and stains are negative in simple myonecrosis.
  Creatine kinase may be normal or increased probably depending upon the stage of the condition when sampling is undertaken.  ESR is elevated. Planar X-ray reveals soft tissue swelling and may potentially show gas within necrotic muscle, Bone scan may show non specific uptake later in the course.   CT shows muscle oedema with preserved tissue planes (non-contrast enhancing). MRI is the exam of choice and shows increased signal on T2 weighted images within areas of muscle oedema.  Contrast enhancement is helpful but must be weighed against the risk of Nephrogenic Systemic Fibrosis as many diabetics have underlying chronic kidney disease. Arteriography reveals large and medium vessel arteriosclerosis occasionally with dye within the area of tissue infarction. Electromyography shows non specific focal changes.
caption: Axial fat suppressed post gadolinium contrast enhancement MRI image showing absent enhancement in the left thigh adductor muscles centrally indicating necrosis in diabetic myonecrosis.
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