CLINICAL VIGNETTE |
Sciatic nerve entrapment secondary to heterotopic ossification: imaging findings and potential effect of selective cox-2 inhibitors
Correspondence to: F. Cotton. E-mail: francois.cotton{at}chu-lyon.fr
A young woman was admitted with a 3-week history of pain and restricted mobility. Six weeks previously she had developed sudden respiratory distress and was successfully extubated 3 weeks after this episode, and later she returned home. On examination she had weakness in the muscles of the right lower extremity, almost exclusively in the territory of the tibial nerve. The diagnosis of neurogenic heterotopic ossification (NHO) was established by X-ray. Axial CT scanning of the pelvis demonstrated NHO that had developed along the fibres of the obturator internus muscle (straight black arrows) and between the obturator internus muscle and the gluteus maximus muscle (straight white arrows), including the sciatic nerve (white star). High signal on T1-weighted pelvic MRI images with gadolinium-DTPA injection was also demonstrated inside the NHO and around the right sciatic nerve (black stars).
Following treatment with 3 weeks of selective cox-2 inhibitors, the range of motion improved. Surgical release of the sciatic nerve was not appropriate because of her improvement and the presence of significant inflammatory phenomena on MRI.
Our case illustrates the importance of radiology in therapeutic decisions. The MRI clearly highlighted inflammatory phenomena [1] around the sciatic nerve. Our observation suggests that a study to assess the effectiveness of selective cox-2 inhibitors in inhibiting NHO would be of interest.
The authors have declared no conflicts of interest.
|
References
- Ledermann HP, Schweitzer ME, Morrison WB. Pelvic heterotopic ossification: MR imaging characteristics. Radiology 2002;222:189–95.
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||