Mackiewicz-Milewska Magdalena, Cisowska-Adamiak Małgorzata, Sakwińska Katarzyna, Szymkuć-Bukowska Iwona, Głowacka-Mrotek Iwona
Department of Rehabilitation, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-094 Bydgoszcz, Poland.
Int J Environ Res Public Health. 2021 Apr 16;18(8):4219. doi: 10.3390/ijerph18084219.
Diagnosis of the cause of massive edema of the lower limbs in patients after spinal cord injury (SCI) can be difficult because of loss of pain sensation, commonly occurring in this group of patients. This paper reviews several different pathologies that can lead to lower-limb edema and the associated diagnostic difficulties. We present four cases of patients with massive edemas of lower limbs at different times after SCI undergoing treatment in the Department of Rehabilitation, University Hospital in Bydgoszcz, Poland. All patients had a lack of pain sensation in the lower limbs and significantly elevated levels of D-dimer. In two cases, deep vein thrombosis (DVT) and intramuscular hematomas (IHs) were diagnosed. IHs were probably a consequence of antithrombotic treatments implemented due to the occurrence of DVT. Heterotopic ossification (HO) was diagnosed in a third case, and, in another patient, who was hospitalized for the longest period after injury, we found humeral bone fractures. Heterotopic ossification, intramuscular haematomas, and bone fractures of the lower limb can mimic DVT. Careful observation of the edema evolution is recommended, as the onset of new symptoms may indicate a different cause of edema from that initially established.
脊髓损伤（SCI）患者下肢出现大量水肿的病因诊断可能存在困难，因为这类患者通常会出现痛觉丧失。本文综述了几种可导致下肢水肿的不同病理情况以及相关的诊断难点。我们呈现了4例在波兰比得哥什大学医院康复科接受治疗的SCI患者，他们在不同时间出现了下肢大量水肿。所有患者下肢均缺乏痛觉，且D - 二聚体水平显著升高。其中2例诊断为深静脉血栓形成（DVT）和肌内血肿（IH）。IH可能是由于DVT的发生而实施抗血栓治疗的结果。第3例诊断为异位骨化（HO），而在另1例受伤后住院时间最长的患者中，我们发现了肱骨骨折。下肢异位骨化、肌内血肿和骨折可能会与DVT相似。建议仔细观察水肿的演变情况，因为新症状的出现可能表明水肿的病因与最初确定的不同。
