Medical Imaging Analysis Report

I. Imaging Findings

1. The anteroposterior (AP) X-ray of the pelvis shows bilateral artificial hip joint prostheses with reduced bone density, indicating a certain degree of bone loss.
2. Irregular calcifications are visible in the soft tissues around both hips and the proximal thighs, distributed subcutaneously and within muscle compartments; some regions demonstrate extensive band-like or clustered deposits.
3. The chest X-ray (PA view) suggests generally normal pulmonary translucency without obvious localized consolidation or cavitation. However, vigilance is advised for potential opportunistic infections or small focal lesions under immunosuppressed conditions.

II. Potential Diagnoses

Based on the patient’s clinical manifestations (skin rash, muscle weakness), along with imaging findings of soft tissue calcification and bone loss, the following diagnoses or differential diagnoses should be considered:

1. Dermatomyositis – An inflammatory disorder affecting the skin and skeletal muscles. Characterized by distinctive rashes and muscle weakness, often presenting with soft tissue calcifications.
2. Other connective tissue diseases (e.g., scleroderma, rheumatoid arthritis, systemic lupus erythematosus) – These conditions can also be associated with bone loss and soft tissue calcifications, but the specific nature of skin and muscle involvement may differ from dermatomyositis.
3. Disorders of calcium-phosphorus metabolism (e.g., parathyroid dysfunction, renal osteodystrophy) – Can present with abnormal soft tissue calcification; laboratory tests (serum calcium, phosphate, PTH, etc.) are needed for differentiation.
4. Long-term use of glucocorticoids leading to osteoporosis and femoral head necrosis – The presence of artificial joint replacements suggests a history or current instability of the hip joints. Secondary complications arising from treatments should also be considered.

III. Final Diagnosis

Combining the patient’s age (37 years), typical skin rash, muscle weakness, and previous clinical history (inflammatory myopathy), with imaging findings of subcutaneous and intramuscular calcifications and decreased bone density, the most consistent diagnosis is Dermatomyositis.
Further confirmation may require additional tests such as muscle enzymes (CK, LDH), electromyography, and muscle biopsy. Screening for potential complications—e.g., opportunistic lung infections or osteonecrosis—should also be considered.

IV. Treatment Plan and Rehabilitation

The primary treatment for dermatomyositis involves glucocorticoids and immunosuppressive therapy, potentially combined with intravenous immunoglobulins. Surgical intervention could be considered in cases of severe joint or soft tissue involvement.
During the course of treatment, regular monitoring of muscle enzymes and lung function is essential, and vigilance for osteoporosis, aseptic necrosis, and opportunistic infections is recommended.

Rehabilitation/Exercise Prescription (FITT-VP Principle)

• Frequency: 3–4 sessions per week of low-intensity aerobic and basic resistance training.
• Intensity: Light to moderate (patient-perceived exertion of 3–5 on a 10-point scale), avoiding excessive exertion in one session.
• Time: 20–30 minutes per session, gradually extending to 40 minutes based on patient tolerance.
• Type: Start with non-weight-bearing exercises (e.g., swimming or elliptical training), then progressively add light-to-moderate resistance work (using small dumbbells or resistance bands).
• Progression: As symptoms improve and muscle strength increases, training intensity and duration can be incrementally raised under the guidance of a specialist or rehabilitation therapist.
• Precautions: In cases of severe bone fragility or a history of joint disease, ensure stable movements at a slow pace to prevent falls or trauma.

During acute flare-ups or when the condition is unstable, it is advisable to reduce exercise intensity and duration. Once muscle inflammation stabilizes, exercise volume should be gradually increased to avoid exacerbation or new injuries.