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MYOSITIS
OSSIFICANS
B R I A N E . WA L C Z A K , D O
C H R I S TO P H E R N . J O H N S O N , D O
B . M AT T H E W H O W E , M D
INTRODUCTION
The serum alkaline phosphatase (SAP) level initially remains normal but after 3 weeks,
in parallel with bone formation, becomes acutely elevated. Levels peak (1.3 to 13.4 times normal) at
approximately 10 weeks and return to normal by 18 weeks. The SAP level cannot be used to
determine the maturity or activity of a lesion and can remain normal even in active lesions.
Acute phase reactants, including the C-reactive protein level, erythrocyte sedimentation rate, and
prostagandin-E2 serum level, are elevated during the initial stages of MO.
Calcium level typically decreases for a short period and then returns to normal before the rise in
SAP.
Creatine phosphokinase level is generally elevated if there is involvement of muscle and, unlike SAP,
may be predictive for the subsequent development and severity of MO
IMAGING
Ultrasonography(USG) as an initial diagnostic test. Thomas et al demonstrated the
role of ultrasonography in the early diagnosis of heterotopic bone formation. They described
three concentric zones: an outer hypoechoic zone that surrounds the lesion, a middle
hyperechoic zone that corresponds to the calcifying rim, and a central hypoechoic zone that
corresponds to the central fibroblastic stroma
Confirmation is recommended with CT or correlation with serial radiographs to confirm the
classic zone of peripheral mature calcification.
Radiographs for MO mature phase when the patients clinical presentation correlates.
Initial plain radiographs of MO in the first 2 weeks are typically normal but occasionally
demonstrate periosteal reaction, possibly because of associated subperiosteal hematoma, and
can be associated with adherence to the periosteum.
A soft-tissue mass may be noticed in the radiographs of acute MO. Soft-tissue calcifications
begin to become apparent radiographically at approximately 3 to 4 weeks.
The calcifications may first appear as amorphous and flocculent. The calcifications typically
become more peripherally oriented and coarse in appearance. These calcifications mature
during the next several weeks to produce a densely calcified peripheral rim with a lucent
center, typically around 6 to 8 weeks.
A follow-up AP radiograph of the shoulder
confirms the diagnosis. Note the
characteristic mature peripheral
calcifications.
Potential mimickers of
myositis ossificans.
illustrating a parosteal
osteosarcoma of the femur