PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of bmjcrBMJ Case ReportsVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
 
BMJ Case Rep. 2015; 2015: bcr2015212462.
Published online 2015 September 18. doi:  10.1136/bcr-2015-212462
PMCID: PMC4577619

Tibialis anterior muscle hernia: a rare differential of a soft tissue tumour

Description

A 57-year-old man with a history of fall injury presented with swelling in the anterior aspect of his left leg, with occasional pain while walking. On examination, the swelling had a rubbery consistency and was partly reducible. The swelling increased in size on standing and activity. Differentials including superficial varicosity, vascular malformation, muscle hernia and soft tissue tumour were considered and MRI was carried out.

MRI showed protrusion of the tibialis anterior through a focal defect in fascia overlying the muscle (figure 1). The defect measured 1.5×1.4 cm. There was a subtle T2 and short τ inversion recovery hyperintense signal within the herniated muscle, possibly due to oedema (figures 2 and 3). A diagnosis of tibialis anterior muscle hernia was confirmed and the patient was managed with compression stockings and activity restriction.

Figure 1
Axial T1 image showing protrusion of the tibialis anterior muscle (white arrow) through a focal defect in the overlying fascia (black arrows).
Figure 2
Axial short τ inversion recovery image showing subtle hyperintensity within the herniated muscle (white arrow), representing oedema.
Figure 3
Sagittal short τ inversion recovery image showing protrusion of the subtly hyperintense muscle (white arrow) through the defect.

Ihde1 classified the aetiology of muscle hernias into traumatic and constitutional (generalised weakness of fascia). In the lower limb, the most commonly involved muscle is the tibialis anterior due to its weak and vulnerable fascia. A dynamic ultrasonogram or MRI can confirm the diagnosis.2 The treatment of muscle hernias depends on the severity of symptoms. While they can be managed conservatively with compression stockings and activity restriction, persistently symptomatic muscle hernias need longitudinal fasciotomy.2

Learning points

  • Muscle hernia should be considered in the differential of reducible or compressible soft tissue mass.
  • Muscle hernias increase in size on activity and standing.
  • Dynamic ultrasonogram or MRI can demonstrate the focal fascial defect and the muscle protrusion through it.

Footnotes

Contributors: AG participated in interpretation of radiological data, reviewed the scientific literature, and drafted and finalised the manuscript. AI supervised the article design, and critically evaluated and finalised the article.

Competing interests: None declared.

Patient consent: Obtained.

Provenance and peer review: Not commissioned; externally peer reviewed.

References

1. Ihde H. On muscular hernia of the leg. Acta Chir Scand 1929;65:97–120.
2. Nguyen JT, Nguyen JL, Wheatley MJ et al. Muscle hernias of the leg: a case report and comprehensive review of the literature. Can J Plast Surg 2013;21:243–7. [PMC free article] [PubMed]

Articles from BMJ Case Reports are provided here courtesy of BMJ Publishing Group