Spectrum of imaging findings of local adverse effects of anabolic steroid use

Transcription

1 Spectrum of imaging findings of local adverse effects of anabolic steroid use Poster No.: C-2350 Congress: ECR 2010 Type: Educational Exhibit Topic: Musculoskeletal Authors: H. Gupta, V. Bhat, S. Edward, P. Robinson ; Leeds/UK, Hull/ UK Keywords: anabolic steroids, local adverse effetcs, ultrasound and MRI DOI: /ecr2010/C Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 12

2 Learning objectives To illustrate the spectrum of soft tissue imaging appearances of anabolic steroid injection site adverse effects. Background Use of anabolic steroids has become widespread among athletes, especially bodybuilders with self-administration by intramuscular injection. Systemic side effects are well recognized but there are also a number of local adverse effects at the injection sites. Soft tissue changes can present at varying duration after injection and as athletes may not be forthcoming with a full history, diagnosis can sometimes be challenging. Local adverse effects include soft tissue infection (pyomyositis), septic arthritis, nerve injury, fat necrosis, rhabdomyolysis and dystrophic calcification. Some complications particularly infections require immediate clinical attention. Imaging findings OR Procedure details Imaging is often required in these cases and can demonstrate abnormality in the subcutaneous fat, muscle, fascial planes or joints. We present imaging findings (ultrasound and MRI) of complications ranging from acute to subacute to chronic. FIGURES 1,2,3 24 year old male presenting after 48 hours of injection into lateral aspect of proximal thigh with swelling at the injection site and thigh. US findings showed myositis in vastus lateralis (figures 1,2) with presence of fluid tracking (figure 3) between the vastus lateralis and rectus femoris. FIGURES 4,5 30 year old male presenting with 1 year history of swelling in the gluteal region bilaterally which had increased in size and become painful over the last few months. Page 2 of 12

3 US showed lobular heterogenous abnormality in the subcutaneous fat = fat necrosis. FIGURES 6,7 24 year old male presenting with 2 week history of swelling in left deltoid presenting as a painless firm mass. US showed illdefined hypoechoeic swelling in the deltoid with anechoeic centre = myonecrosis. FIGURES 8,9 Example of injection site myonecrosis on MRI FIGURE 10 Example of injection site fat necrosis on MRI Images for this section: Fig. 1: Myositis Vastus lateralis Page 3 of 12

4 Fig. 2 Page 4 of 12

5 Fig. 3: Fascitis Page 5 of 12

6 Fig. 4: fat necrosis Page 6 of 12

7 Fig. 5 Fig. 6 Page 7 of 12

8 Fig. 7: myonecrosis Page 8 of 12

9 Fig. 8: myonecrosis Page 9 of 12

10 Fig. 9 Page 10 of 12

11 Fig. 10: fat necrosis Page 11 of 12

12 Conclusion Anabolic steroid use is commonly practiced among athletes, particularly amateur body builders. Imaging features can suggest abuse when a history is not immediately forthcoming and is also important in demonstrating the extent and severity of local complications. Personal Information Dr Harun Gupta (harun.gupta@nhs.net); Dr Philip Robinson (p.robinson@leedsth.nhs.uk) Leeds Teaching Hospitals Musculoskeletal Centre X-Ray Dept Chapel Allerton Hospital Leeds UK References NONE Page 12 of 12