Lung metastasis induced chronic compartment syndrome of the lower leg

<p class="abstract">Compartment syndrome occurs when the pressure within a defined compartmental space increases above a critical pressure threshold. Lung cancer is one of the world's most frequently diagnosed cancer whose metastases are rare cause of compartment syndrome. We present a 50 year old male patient who was admitted to our emergency department due to painful left lower leg, swelling and paresthesia of the medial side of the foot that lasted about 2 months back. The diagnosis of metastatic lung adenocarcinoma was set 9 months earlier. Physical examination revealed an ill-defined, tense, and tender swelling left calf and X-ray images confirmed periosteal reaction on all four cortices of both bones without osteolytic lesions. After an adequate laboratory analyses and preoperative preparation, debridement with biopsy and fasciotomy was performed. Histopathological evaluation showed necrotic tumor tissue that morphologically and immunohistochemically corresponds to lung cancer. We performed an above knee amputation and the next day, the patient was discharged home, due to his personal request.</p>

Síndrome compartimental crónico del antebrazo tratado con fasciotomía mínimamente invasiva: reporte de un caso. [Chronic compartment syndrome of the forearm treated with minimally invasive fasciotomy: A case report]

El síndrome compartimental crónico inducido por el ejercicio o el uso excesivo raramente afecta a los miembros superiores y se ha relacionado con actividades deportivas o laborales. Describimos un caso de un paciente con diagnóstico de síndrome compartimental crónico de antebrazo, de características poco habituales, tratado con fasciotomía mínimamente invasiva. Este síndrome debe sospecharse incluso en pacientes que no practiquen actividades de riesgo y que sufran dolor compartimental inespecífico. La fasciotomía con técnica mínimamente invasiva es una opción eficaz para curar este cuadro. ABSTRACTChronic exertional compartment syndrome (CECS) of the forearm is uncommon and has been described in association with sport and work-related activities. We describe the uncommon presentation of a patient with CECS of the forearm who was treated through a min-invasive fasciotomy. CECS of the forearm must be suspected in patients with compartmental pain even if they do not practice risk activities. Mini-invasive fasciotomy is an effective option for the treatment of this pathology.

Skeletal Muscle Lymphoma Presenting with Chronic Compartment Syndrome of Leg after Trauma

Compartment syndrome may be acute or chronic based on the clinical course and etiology. Here, we report the first known case to be diagnosed with skeletal muscle-derived B-cell lymphoma presenting with chronic compartment syndrome after trauma. A 62-year-old woman sought medical attention due to a one-month history of painful left lower leg swelling and paresthesia of the medial side of the foot after falling over. The patient underwent fasciotomy and debridement under the preoperative diagnosis of fasciitis and myositis with associated compressive neuropathy. Preoperative laboratory tests were within normal limits. Postoperative pathologic examination and bone marrow aspiration revealed B-cell lymphoma with bone marrow involvement postoperatively. Tumor lysis syndrome took place, presenting with drowsiness, poor appetite, and oliguria, after the operation along with multiple organ failure. Awareness of the differential diagnoses of compartment syndrome in such clinical situation is crucial because it may lead to different examination and treatment plan preoperatively.

Chronic Compartment Syndrome of the Mobile Wad: A Case Report

A case of chronic compartment syndrome of the mobile wad in a 15-year-old female amateur tennis player is described. She presented with a 7-month history of radial forearm pain and tenderness with mild swelling, and was unable to swing the tennis racket. MRI showed high intensity within the brachioradialis muscle. Endoscopic fasciotomy showed degeneration of the brachioradialis muscle belly. Complete pain relief was obtained 4 months after the fasciotomy.

Prevalence of chronic compartment syndrome of the legs: Implications for clinical diagnostic criteria and therapy

IntroductionPoorly defined musculoskeletal disorders are a common clinical problem and have considerable psychosocial impact. Chronic compartment syndrome (CCS) of the legs has primarily been noted in young athletes and soldiers. The epidemiology of CCS in the general population has not been studied previously. The aim of this study was to establish the prevalence of CCS of the legs in the general population and to study its association with possible etiological factors.MethodsA two-stage population survey was performed, using a questionnaire followed by clinical examination. A sample of 3000 individuals aged 25-75 years was randomly selected from the general population. A clinical examination was offered to those answering “Yes” to the following question: “Do you wake up at nights due to leg pains or cramps, causing you to walk around?” Intracompartmental pressures in the leg were measured in 13 persons randomly selected from among those diagnosed with CCS after the clinical examination.ResultsOf the 3000 persons contacted, 2308 (76.9%) responders were included in the study. Leg pain or cramps at night was reported by 24% of the respondents. Age, rheumatic disease, use of hormone medication, heart failure, leg oedema, and peripheral arterial disease were all significantly associated with leg pain or cramps (P< 0.05). Among 286 persons with leg pain who underwent a subsequent clinical examination, 91 persons (31.9%) were classified as definite CCS. This suggests a CCS prevalence of 7.6% in the total sample ([24% x 31.9%/100]). In 13 of the individuals with CCS intracompartmental pressure was measured before and after performance of the step test exercise. One individual had a post-exercise pressure >15 mmHg. None had post-exercise pressure past the conventional threshold of >30 mmHg.ConclusionNocturnal leg pain or cramps is a common symptom. A significant part of the general population (7.6%) may have CCS of the legs, with symptoms ranging from very mild to severe.ImplicationsConsidering the high prevalence of CCS found in this study, it is likely that a large proportion of those presenting with muscular pain actually have CCS. These persons are usually advised to increase their physical training to achieve some degree of pain relief. However, CCS patients may instead experience both increased leg pain and a proximal myalgia, which is possibly a referred pain. A demanding “gold standard” test (requiring identification of elevated of intracompartmental pressures), unclear diagnostic criteria, poor long-term results from incomplete surgery, and an uncertain explanation for what may be termed referred pain seem to have delayed the acceptance of CCS as a common cause of leg pain/cramps and numbness. At the same time, the enormous costs to society and the reduced quality of life of patients require that such disease entities are correctly diagnosed as they can be effectively treated by simple, low-risk surgical procedures.