Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.602
Peer-review started: October 23, 2016
First decision: February 17, 2017
Revised: February 28, 2017
Accepted: April 18, 2017
Article in press: April 20, 2017
Published online: July 18, 2017
A 75-year-old man presented with knee pain due to medial osteoarthritis of the knee in the orthopedic outpatient clinic. Conservative treatment was started with steroid infiltration. Besides his knee complaint reported a bilateral painless swollen calf muscle without traumatic cause, and also without any pain at night, fever or medical illness. On physical examination the soleus muscle had a swollen aspect in both calfs. The skin appeared normal without deformities and the arterial pulsations were intact. An X-ray did not show abnormalities in the tibia. Magnetic resonance imaging of the legs revealed bilateral multiple saccular intramuscular venous malformations involving the soleus muscle. Intramuscular venous malformations in skeletal muscles are rare, especially when the occurrence is bilateral. Bilateral venous malformations have the potential to be missed because of the intramuscular localization. Symptoms of intramuscular venous malformation can be often mild and overlap with non-exercise related compartment syndrome, claudication, lymphedema and post thrombotic syndrome or muscle strains.
Core tip: Intramuscular venous malformations involving in the skeletal muscles are rare, especially when occurrence of these lesions is bilateral. These lesions are easily missed due to intramuscular localization. We report a rare presentation of these lesions arising from the soleus muscle on both sides in a 75-year-old man, diagnosed with magnetic resonance imaging of the legs. When the lesions are asymptomatic conservative treatment is preferred. When the appearance is symptomatic surgical resection or sclerotherapy can be an option.