Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2017; 8(7): 602-605
Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.602
Painless swollen calf muscles of a 75-year-old patient caused by bilateral venous malformations
Roderick S M Piekaar, Eline W Zwitser, Paul P A Hedeman Joosten, Joris A Jansen
Roderick S M Piekaar, Eline W Zwitser, Joris A Jansen, Department of orthopaedic surgery, Alrijne Hospital, 2353 GA Leiderdorp, The Netherlands
Paul P A Hedeman Joosten, Department of vascular surgery, Alrijne Hospital, 2353 GA Leiderdorp, The Netherlands
Author contributions: All authors contributed to the acquisition of the writing and revision of this manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at the Alrijne Hospital in Leiderdorp.
Informed consent statement: The patient involved in this case report gave his written informed consent authorizing use and disclosure of his protected health information.
Conflict-of-interest statement: All the authors have no conflicts of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Roderick S M Piekaar, MD, Registrar Orthopedics, Department of orthopaedic surgery, Alrijne Hospital, Simon Smitweg 1, 2353 GA Leiderdorp, The Netherlands.
Telephone: +31-6-20885398
Received: October 23, 2016
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.

Keywords: Venous malformations, Bilateral intramuscular venous malformation, Swollen calf muscles

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.