Mohamed Momen, Karar Ismail, Dirar Mohamed Ibrahim
Department of Plastic Surgery, Elnou Hospital, Omdurman, Sudan; Sudan Medical Specialization Board (SMSB), Khartoum, Sudan.
Department of Plastic Surgery, Military Hospital Helipad, Omdurman, Sudan.
Int J Surg Case Rep. 2024 Mar;116:109361. doi: 10.1016/j.ijscr.2024.109361. Epub 2024 Feb 8.
The presentation of spontaneous hematomas remains different between all affected populations, but advanced age and use of anticoagulants are common risk factors in the majority. The progression of the hematoma may require some time to be detected; however, it can prove fatal if it reaches a significant size. A spontaneous calf hematoma can be mistakenly diagnosed as deep vein thrombosis, and the management of both conditions is varying.
A 26-year-old man had recently undergone multiple left lower limb surgeries and was using Rivaroxaban for deep vein thrombosis prophylaxis. He presented with a painful contralateral calf swelling for a duration of one month, which was later diagnosed as a spontaneous chronic calf hematoma. Despite the fact that blood tests were within the normal range, imaging confirmed the diagnosis. After extensive discussion among multidisciplinary teams, a surgical exploration was conducted, resulting in the complete evacuation of the hematoma. Subsequently, a meticulous monitoring of the re-administration of anticoagulant was conducted. CLINICAL DISCUSSION: spontaneous calf hematoma is not common pathology and affecting elderly and presentation in young is unique and diagnosis will not be reached easily especially in chronic case.
A spontaneous calf hematoma can occur in a young, fit population with coexisting anticoagulant administrations. A thorough history, examination, and imaging must be applied urgently in order to reach a diagnosis.
自发性血肿在所有受影响人群中的表现各不相同，但高龄和使用抗凝剂是大多数情况下的常见危险因素。血肿的进展可能需要一段时间才能被发现；然而，如果血肿达到相当大的规模，可能会致命。自发性小腿血肿可能会被误诊为深静脉血栓形成，而且这两种病症的治疗方法也有所不同。
一名26岁男性近期接受了多次左下肢手术，并正在使用利伐沙班预防深静脉血栓形成。他出现对侧小腿疼痛性肿胀达1个月，后来被诊断为自发性慢性小腿血肿。尽管血液检查结果在正常范围内，但影像学检查确诊了该病症。多学科团队进行广泛讨论后，进行了手术探查，血肿得以完全清除。随后，对抗凝剂的重新使用进行了细致监测。
自发性小腿血肿并非常见病症，在老年人中较为常见，而在年轻人中出现则较为独特，尤其是在慢性病例中，不容易做出诊断。
自发性小腿血肿可能发生在同时使用抗凝剂的年轻健康人群中。必须立即进行全面的病史询问、体格检查和影像学检查以做出诊断。
