Adult Male with Soleus Muscle Venous Malformation: A Case Report
PM & R
Case Diagnosis: A 39-year-old male experiencing persistent right calf pain, exacerbated by activity diagnosed with a soleus muscle venous malformation. Case Description: Patient graduated from the United States Airforce Academy and participated in numerous athletic events including triathlons. However, over the period of a year he was having right upper-third calf pain. He had been evaluated by multiple sports medicine specialists and tried physical therapy, stretching, night splints and multiple orthotics without relief. The pain was inconsistent as he stated he could run varying distances before the onset of pain. He denied major swelling, skin discoloration or signs of infection. On examination, patient’s lower extremities were neurovascularly intact with full sensation and strength, and no signs of DVT, swelling or erythema. Setting: Outpatient Clinic Assessment/Results: The only positive examination finding was tenderness over the upper-third of the right calf. Patient’s X-ray of the right tibia and fibula showed no fracture; however, small calcific densities were seen overlying the posterior soft tissue. MRI demonstrated an intramuscular lesion of increased signal intensity measuring 7.9cm x 4.2cm x 2.8 cm in the right soleus muscle accordant with venous malformation. Patient was referred to a vascular surgeon who recommended sclerotherapy. Discussion: Intramuscular malformations are not commonly seen in clinical practice. An MRI is the best testing modality to detect early signs of vascular malformations. Conservative treatments such as low dose aspirin and compression socks are first line treatments. Sclerotherapy should be considered the next line of treatment if the patient’s function is limited due to pain burden. Conclusion: Venous malformation symptoms can easily be misdiagnosed as muscle strain or other forms of myofascial syndromes. Level of Evidence: Level V
Garelik L, Maltese JT. Adult male with soleus muscle venous malformation: a case report. 2021 Nov 19; PM & R 13(S1):S74.