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Delayed presentation of compartment syndrome of the thigh secondary to quadriceps trauma and vascular injury in a soccer athlete.

How MI, Lee PK, Wei TS, Chong CT - Int J Surg Case Rep (2015)

Bottom Line: Decompressive fasciotomy and vein repair performed with subsequent split-skin grafting of the wound defect resulted in a good functional outcome at 2-years follow-up.Vascular injury can cause thigh compartment syndrome in sports trauma.MRI findings of deep thigh muscle swelling and "blow-out" tear of the vastus lateralis are strongly suggestive of severe quadriceps injury, and may be a harbinger of delayed thigh compartment syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics Surgery, Changi General Hospital, Singapore. Electronic address: zell53@hotmail.com.

No MeSH data available.


Related in: MedlinePlus

MRI of the right thigh (sagittal view) showing grossly swollen vastus intermedius muscle (small arrows) and a large hematoma displacing surrounding structures (large arrow).
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fig0010: MRI of the right thigh (sagittal view) showing grossly swollen vastus intermedius muscle (small arrows) and a large hematoma displacing surrounding structures (large arrow).

Mentions: However, 4 days later and without further trauma, the patient experienced severe constant pain in his right thigh. He recalled that the pain had acutely worsened and was not relieved by analgesia on the day prior to admission. He was unable to ambulate on the affected leg, and denied any paresthesia. At presentation the right thigh was tense, swollen, and tender (Fig. 1). The circumference of the right thigh was 8 cm larger than that of the left. Passive knee movement exacerbated the pain in the right thigh. The peripheral pulses were normal and remained symmetric. Neurologic examination of the lower limb was unremarkable. An urgent MRI of the right thigh was performed, which showed a large 11.7 × 7.6 × 6.9-cm hematoma within the swollen vastus intermedius muscle with significant surrounding mass effect, and a high-grade tear of the distal half of the posterior fibers of the vastus lateralis muscle (Fig. 2). Computed tomographic (CT) angiography of the lower extremity did not demonstrate active contrast extravasation in the arterial and venous phases.


Delayed presentation of compartment syndrome of the thigh secondary to quadriceps trauma and vascular injury in a soccer athlete.

How MI, Lee PK, Wei TS, Chong CT - Int J Surg Case Rep (2015)

MRI of the right thigh (sagittal view) showing grossly swollen vastus intermedius muscle (small arrows) and a large hematoma displacing surrounding structures (large arrow).
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4446675&req=5

fig0010: MRI of the right thigh (sagittal view) showing grossly swollen vastus intermedius muscle (small arrows) and a large hematoma displacing surrounding structures (large arrow).
Mentions: However, 4 days later and without further trauma, the patient experienced severe constant pain in his right thigh. He recalled that the pain had acutely worsened and was not relieved by analgesia on the day prior to admission. He was unable to ambulate on the affected leg, and denied any paresthesia. At presentation the right thigh was tense, swollen, and tender (Fig. 1). The circumference of the right thigh was 8 cm larger than that of the left. Passive knee movement exacerbated the pain in the right thigh. The peripheral pulses were normal and remained symmetric. Neurologic examination of the lower limb was unremarkable. An urgent MRI of the right thigh was performed, which showed a large 11.7 × 7.6 × 6.9-cm hematoma within the swollen vastus intermedius muscle with significant surrounding mass effect, and a high-grade tear of the distal half of the posterior fibers of the vastus lateralis muscle (Fig. 2). Computed tomographic (CT) angiography of the lower extremity did not demonstrate active contrast extravasation in the arterial and venous phases.

Bottom Line: Decompressive fasciotomy and vein repair performed with subsequent split-skin grafting of the wound defect resulted in a good functional outcome at 2-years follow-up.Vascular injury can cause thigh compartment syndrome in sports trauma.MRI findings of deep thigh muscle swelling and "blow-out" tear of the vastus lateralis are strongly suggestive of severe quadriceps injury, and may be a harbinger of delayed thigh compartment syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics Surgery, Changi General Hospital, Singapore. Electronic address: zell53@hotmail.com.

No MeSH data available.


Related in: MedlinePlus