Postoperative Rhabdomyolysis in the Bilateral Shoulder Areas After Cardiac Surgery

Abstract

Rhabdomyolysis (RML) is a disease that results from the death of muscle fibers and the release of intracellular contents into the bloodstream as a result of traumatic or non-traumatic muscle injury. Postoperative RML is a rare complication that may result from improper patient positioning, extended surgery time, or unique patient risk factors. We describe a case of a 43-year-old obese male who presented with postoperative bilateral shoulder RML after undergoing cardiothoracic surgery for aortic valve disease. To our knowledge, after a thorough review of the literature using PubMed, Medline, and Google Scholar, no previous studies have reported positioning injuries specific to obese cardiac surgical patients and their relation to RML.

Keywords: bilateral; postoperative; rhabdomyolysis; shoulders; surgery.

Figure 1. Postoperative bilateral shoulder rhabdomyolysis following cardiothoracic surgery confirmed with MRIs of bilateral shoulders without contrast.

(A) Sagittal oblique T1-weighted MRI of the right shoulder. (B) Sagittal oblique T2-weighted MRI of the right shoulder. (C) Axial MRI of the right shoulder. (D) Coronal oblique T2-weighted MRI of the right shoulder. (E) Sagittal oblique T1-weighted MRI of the left shoulder. (F) Sagittal oblique T2-weighted MRI of the left shoulder. (G) Axial MRI of the left shoulder. (H) Coronal oblique T2-weighted MRI of the left shoulder. MRIs in multiple planes of bilateral shoulders demonstrate intramuscular hemorrhage involving the supraspinatus muscles bilaterally, prominent intramuscular edema of the infraspinatus, and teres minor muscles bilaterally, and mild edema in the posterior deltoid and trapezius muscles bilaterally.