Muscle compromise in diabetes

Muscle compromise associated with diabetes includes muscle infarction, myositis, pyomyositis, and abscess formation. These conditions may also be seen in various other conditions, such as trauma, alcoholism, neoplasia, vasculopathy, HIV infection, and other immunocompromised states and hemoglobinopathies. Due to recent advances in imaging technology, these entities are readily detected and treated at an earlier stage. Different diagnostic modalities may be used, particularly magnetic resonance imaging (MRI), which is best for soft-tissue pathologies. Muscle infarction appears with acute edema and inflammatory changes on T1- and T2-weighted images, enhancing peripherally postcontrast, and nonenhancing central areas suggestive of necrosis, lacking focal fluid collections. The latter feature may help to exclude abscesses, as these mostly present with fluid collections. Pyomyositis in its early period demonstrates ill-defined muscle enlargement with increased signal on T2-weighted images. Myositis shows no signal changes or mild hypointensity on T1-weighted images, but diffuse hyperintensity on T2-weighted images, with no or minimal enhancement following intravenous contrast media. Recognition of these pathologies is important, since management approaches vary depending on the etiology of the muscle involvement and overall status of the patient.