Zervikale Myositis ossificans bei einem 47-jährigen Patienten

Zusammenfassung

Hintergrund: Die Myositis ossificans stellt eine heterotope Verknöcherung von Bindegewebe dar, welche bei Progredienz zu funktionellen Beschwerden führt. Die zervikale Lokalisation ist dabei selten. Die klinischen Symptome sind unspezifisch. Wegweisend kann ein vorangegangenes Trauma in der Eigenanamnese sein. Kasuistik: Bei einem 47-jährigen Patienten mit dorsozervikaler Raumforderung wurde nach radiologischer Bildgebung und bioptisch histologischer Diagnosestellung eine ca. 5 × 4 × 4 cm große Myositis ossificans reseziert, welche zu funktionellen Beschwerden geführt hatte. Schlussfolgerung: Bei zervikalen Raumforderungen muss bei radiologischem Hinweis einer partiellen Kalzifizierung differenzialdiagnostisch neben einer Tuberkulose und Sarkomen an eine Myositis ossificans gedacht werden. Bei Progredienz und funktionellen Beschwerden ist die Therapie der Wahl die vollständige operative Entfernung und postoperative Rezidivprophylaxe mit Indometacin.

Abstract

Background: Myositis ossificans is a heterotopic ossification of the soft tissue, which leads in progredient cases to functional disorder. Cervical localization is a rare entity. The clinical symptoms are more or less unspecific. Indicating is a foregoing trauma of the affected region. Case report: We report about a 47 year old male patient with a dorsocervical mass, which had caused dysfunction. He was operated after the diagnosis had been histologically and radiologically confirmed. Conclusions: In case of cervical tumors with radiological evidence of partial calcification differential diagnosis should keep in mind myositis ossificans next to tuberculosis or sarcoma. Surgery and postoperative prophylaxis with Indometacin is the therapy of choice.

Myositis ossificans - zervikal - Kalzifikation

myositis ossificans - neck - calcification

Literatur

• 1 Dudkiewicz I, Salai M, Chechik A. A young athlete with myositis ossificans of the neck presenting as a soft-tissue tumour.  Arch Orthop Trauma Surg. 2001;  121 (4) 234-237
• 2 Mann S S, Som P M, Gumprecht J P. The difficulties of diagnosing myositis ossificans circumscripta in the paraspinal muscles of a human immunodeficiency virus-positive man: magnetic resonance imaging and temporal computed tomographic findings.  Arch Otolaryngol Head Neck Surg. 2000 Jun;  126 (6) 785-788
• 3 Adderson E E, Bohnsack J F. Traumatic myositis ossificans simulating soft tissue infection.  Pediatr Infect Dis J. 1996 Jun;  15 (6) 551-553. No abstract available.
• 4 Read-Jones M, Murty G E, Ward V. Traumatic myositis ossificans of the superior belly of the omohyoid.  J Laryngol Otol. 1999 Sep;  113 (9) 856-857
• 5 Baysal T, Baysal O, Sarac K, Elmali N, Kutlu R, Ersoy Y. Cervical myositis ossificans traumatica: a rare location.  Eur Radiol. 1999;  9 (4) 662-664
• 6 Sarac S, Sennaroglu L, Hosal A S, Sozeri B. Myositis ossificans in the neck.  Eur Arch Otorhinolaryngol. 1999;  256 (4) 199-201
• 7 Takahashi K, Sato K. Myositis ossificans traumatica of the medial pterygoid muscle.  J Oral Maxillofac Surg. 1999Apr;  57 (4) 451-456
• 8 Jepsen M C, Graham S M. Traumatic myositis ossificans of the levator scapulae muscle.  Am J Otolaryngol 1998. Sep-Oct;  19 (5) 345-348
• 9 Kussmaul W G, Esmail A N, Sagar Y, Ross J, Gregory S, Kaplan F S. Pulmonary and cardiac function in advanced fibrodysplasia ossificans progressiva.  Clin Orthop. 1998 Jan;  (346) 104-109
• 10 Smith R. Fibrodysplasia (myositis) ossificans progressiva. Clinical lessons from a rare disease.  Clin Orthop. 1998 Jan;  (346) 7-14
• 11 Meier R, Bolliger K P. Anesthesiologic problems in patients with fibrodysplasia ossificans progressiva.  German Anaesthesist. 1996 Jul;  45 (7) 631-634
• 12 Woolgar J A, Beirne J C, Triantafyllou A. Myositis ossificans traumatica of sternocleidomastoid muscle presenting as cervical lymph-node metastasis.  Int J Oral Maxillofac Surg. 1995 Apr;  24 (2) 170-173
• 13 Lopez Barea F, Rodriguez Peralto J L, Gonzalez Lopez J, Sanchez Perez Grueso F. Case report 694: Cervical paravertebral circumscribed myositis ossificans.  Skeletal Radiol. 1991;  20 (7) 539-542
• 14 Reinig J W, Hill S C, Fang M, Marini J, Zasloff M A. Fibrodysplasia ossificans progressiva: CT appearance.  Radiology. 1986 Apr;  159 (1) 153-157
• 15 Culpepper M I, Niemann K M. High school football injuries in Birmingham, Alabama.  South Med J. 1983 Jul;  76 (7) 873-875, 878
• 16 Ferlito A, Barion U, Nicolai P. Myositis ossificans of the head and neck. Review of the literature and report of a case.  Arch Otorhinolaryngol. 1983;  237 (2) 103-113. No abstract available.
• 17 Shugar M A, Weber A L, Mulvaney T J. Myositis ossificans following radical neck dissection.  Ann Otol Rhinol Laryngol. 1981 Mar-Apr;  90 (2 Pt 1) 169-171
• 18 Thorseth K. A case of traumatic myositis ossificans in the iliopsoas muscle.  Acta Orthop Scand. 1968;  39 (1) 73-75
• 19 Mevio E, Rizzi L, Bernasconi G. Myositis ossificans traumatica of the temporal muscle: a case report.  Auris Nasus Larynx. 2001 Nov;  28 (4) 345-347
• 20 Khaledpour C, Jastrow H, Spiwocks-Becker I. Myositis ossificans des Musculus rectus femoris.  Poster, published in: Ann Anat. 1998;  181 (Suppl) 121
• 21 Katagiri T, Yamaguchi A, Komaki M, Abe E, Takahashi N, Ikeda T, Rosen V, Wozney J M, Fujisawa-Sehara A, Suda T. Bone morphogenetic protein-2 converts the differentiation pathway of C2C12 myoblasts into the osteoblast lineage.  J Cell Biol. 1995 Feb;  128 (4) following 713 Department of Biochemistry, Showa University, Tokyo, Japan.
• 22 Anderson E E, Bohnsack J F. Traumatic myositis ossificans simulating soft tissue infection.  Pediatric Infectious Diseases Journal. 1996;  15 551-553