The patient underwent the emergent decompressive fasciotomy of left lateral compartment and neurolysis of left common peroneal nerve. Considering the clinical findings, MR findings, and intraoperative findings, the patient was given a diagnosis of left common peroneal nerve palsy due to acute isolated lateral compartment syndrome. The musculature of ipsilateral anterior compartment was normal, and there was no evidence of intramuscular hematoma or muscular rupture. The left common peroneal nerve was compressed between the swollen musculature of left lateral compartment and proximal fibula. The color of the peroneus longus and brevis muscles was brownish, and showed necrosis with the loss of activity of the muscles. 1D).Ĭonsidering clinical and MR findings, a preliminary diagnosis was anterior and lateral compartment syndrome with peroneal nerve palsy and the patient was transferred to the operating room. On axial gadolinium-enhanced T1-weighted image, heterogeneous enhancement was noted in the affected muscles of the lateral compartment ( Fig. Focal increased T2-high signal intensity suspected as reactive edema was noted in the extensor digitorum longus and soleus muscles abutting the peroneus longus muscle ( Fig. Fluid layer was noted within the surrounding deep and superficial fascial planes. Diffuse high signal intensity (SI) on T2-weighted image (T2WI) was noted throughout the proximal two-thirds of the peroneus longus and brevis muscles. The MR imaging revealed marked swelling of the peroneus longus and brevis muscles ( Fig. The fat-saturated T2-weighted spin echo sequence had the parameters of repetition time 3800/echo time 80. The patient was examined by using 1.5 T MRI scanner (MAGNETOM Avanto, Siemens Healthcare, München, Germany). The magnetic resonance (MR) imaging was taken for further evaluation. In the initial conventional radiographs of the left lower leg, there was no evidence of fracture or other bony abnormalities. The serum glucose level, platelet count, prothrombin time, and activated partial thromboplastin time were within the normal range. The level of serum creatine kinase was also increased (56.9 ng/mL). The laboratory evaluation showed white blood cell count of 10450 (mm 3, poly 84%) and the erythrocyte sedimentation rate of 33 (normal range : < 20 mm/hr). The sensation of the left lower leg was intact, and the arterial pulses of ipsilateral dorsalis pedis artery and posterior tibial artery were palpable. The motor power of tibialis anterior and extensor hallucis longus muscles of left lower leg were 0/5 and 4/5, respectively (grade 0: no muscle movement grade 4: movement against resistance, but less than normal grade 5: normal strength). Passive dorsiflexion of the left ankle produced significant pain at the anterior aspect of the ipsilateral lower leg and anterolateral aspect of dorsum of the ipsilateral foot. She complained of severe pain when the ankle was passively rotated.
On physical examination, the patient demonstrated a mild swelling of the left lower leg compared with the opposite side. This study presents a magnetic resonance imaging of a case in a 48-year-old female affected with idiopathic acute isolated lateral compartment syndrome of the lower leg with ipsilateral peroneal nerve palsy as a complication, which shows localized enlargement of the peroneal muscles with peripheral convex bowing and change of their signal intensity with fluid signal along the adjacent fascial planes. However, there are few reports of idiopathic acute isolated lateral compartment syndrome, and there is no report of its radiologic findings ( 1- 3). The acute isolated lateral compartment syndrome is less typical and usually associated with minor trauma. It is usually associated with major trauma such as fracture or crushing injury, and most commonly occurs in anterior or deep posterior compartments. Acute compartment syndrome of the lower leg is a surgically emergent condition in which the pressure within the anatomically closed osseofascial compartment rises to reduce arterial and capillary circulation, finally leading to irreversible muscle and nerve damage.
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