Statin-related muscle complications masquerading as soft tissue sarcomas

Abstract

Musculoskeletal injuries are a known side effect of long-term statin use. These injuries include sudden, atraumatic muscle rupture which can cause extremity hematomas that motivate patients to seek evaluation and physicians to send referrals for oncologic workup. We discuss two cases where malignancy was suspected rather than statin-induced muscle injury. Using these cases as examples, we discuss subtleties between the two diagnoses so that muscle rupture may be considered prior to subspecialist referral. This paper aims to serve as a reminder and guide for physicians who encounter long-term statin users with nonspecific, improving musculoskeletal symptoms and hemorrhagic MRI findings that lack nodular or mass-like enhancements. While referral to orthopedic oncology is always encouraged in cases of uncertainty, it may not always be necessary.

Keywords: Hematoma; Orthopedic oncology; Soft-tissue sarcoma; Statin.

Fig. 1

A: Initial MRI demonstrated extensive increased signal on T2 sequences (yellow arrow) throughout the quadriceps musculature with surrounding soft tissue stranding and inflammation. Size of 9.7 cm × 6.8 cm × 21.4 cm. B: Repeat MRI 27 days later with a more loculated appearance of more intense T2 signal (yellow arrow) within the quadriceps muscles, with less diffuse edema in the surrounding tissue which demonstrates peripheral enhancement on contrast studies. Size of 8.41 cm × 5.5 cm × 15.3 cm. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

A: Deep to the fascia the medial calf 13.3 cm × 2.5 cm × 5 cm size well-circumscribed area of increased signal on T2 (yellow arrow) with peripheral enhancement on contrast studies with some surrounding soft tissue edema. B: Demonstrates resolution of the lesion previously appreciated on prior MRI described in panel A. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)