Contrast-enhanced ultrasonography in the emergency evaluation of a thigh muscle hematoma accompanied by active bleeding in a hemophilia A patient

[摘要] Hemophiliacs are at the highest risk of bleedingcomplications. The muscular hematomas (MH) comprise6.8% of visits to the emergency department by hemophiliaA (HA) patients (1). Magnetic resonance imaging (MRI),computed tomography (CT) scanning, and ultrasonography(US) are all used in detecting MHs. In addition, computedtomographic angiography (CTA) can be used to confirmthe presence of contrast extravasation following traumaticinjuries. However, CTA has limitations because it exposespatients to iodinated contrast material and radiation.Due to availability and cost, CT scans and US are morecommonly used than MRIs (2). US imaging has emergedas one of the most useful modalities in evaluating traumaticmuscle injuries. At the acute stage, the hematoma maybe compressible and appear hyperechoic because ofextravasated fresh blood. At the chronic stage, it mayappear less compressible and a mix of anechoic/hypoechoicbecause of the growth of endothelial cells, smooth musclecells, and fibroblasts (3). However, although active bleedingis seldom visible sonographically, a contrast-enhancedultrasonography (CEUS) can detect acute emergenthemorrhage (4).

[学科分类] 外科医学