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Spontaneous elbow hemarthrosis identified by point-of-care ultrasound

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ABSTRACT

Traumatic or spontaneous hemarthroses are an important cause of joint effusions, and can complicate innate or acquired coagulopathies. The elbow is an unusual location for a spontaneous hemarthrosis; we describe a previously unreported case of warfarin-induced spontaneous elbow hemarthrosis, diagnosed by point-of-care ultrasound. On the basis of clinical and ultrasound findings arthrocentesis was deferred, and the patient was successfully treated with warfarin reversal and conservative care. Physical examination is unreliable for the detection of a joint effusion, and misdiagnosis and can lead to unnecessary investigation or resource use. Point-of-care ultrasound allows accurate, prompt, direct visualization of a joint effusion, and non-invasive confirmation of a hemarthrosis. Ultrasound can facilitate accurate diagnosis and characterization of joint effusions to improve the care of patients with coagulopathy.

No MeSH data available.


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Posterior transverse view of the elbow with hemarthrosis (triangle).
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f2-ceem-16-137: Posterior transverse view of the elbow with hemarthrosis (triangle).

Mentions: The treating physician performed point-of-care ultrasound to evaluate the swelling and suspected effusion. Using a high-frequency 10-5 MHz transducer (Sonosite, Bothell, WA, USA), both lateral longitudinal and posterior transverse images of the joint were obtained. The ultrasound images demonstrated a complex, compressible effusion with mixed hyperechoic and hypoechoic content, consistent with a hemarthrosis (Figs. 1, 2) [2-4]. No layering fluid was appreciated to suggest lipohemarthrosis from an intra-articular fracture. Radiographs of the elbow were subsequently obtained, which re-demonstrated an effusion without evidence of fracture (Fig. 3). Laboratory studies were subsequently available, and notable for an INR of 7.9 and hemoglobin 12.8 g/dL.


Spontaneous elbow hemarthrosis identified by point-of-care ultrasound
Posterior transverse view of the elbow with hemarthrosis (triangle).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5385507&req=5

f2-ceem-16-137: Posterior transverse view of the elbow with hemarthrosis (triangle).
Mentions: The treating physician performed point-of-care ultrasound to evaluate the swelling and suspected effusion. Using a high-frequency 10-5 MHz transducer (Sonosite, Bothell, WA, USA), both lateral longitudinal and posterior transverse images of the joint were obtained. The ultrasound images demonstrated a complex, compressible effusion with mixed hyperechoic and hypoechoic content, consistent with a hemarthrosis (Figs. 1, 2) [2-4]. No layering fluid was appreciated to suggest lipohemarthrosis from an intra-articular fracture. Radiographs of the elbow were subsequently obtained, which re-demonstrated an effusion without evidence of fracture (Fig. 3). Laboratory studies were subsequently available, and notable for an INR of 7.9 and hemoglobin 12.8 g/dL.

View Article: PubMed Central - PubMed

ABSTRACT

Traumatic or spontaneous hemarthroses are an important cause of joint effusions, and can complicate innate or acquired coagulopathies. The elbow is an unusual location for a spontaneous hemarthrosis; we describe a previously unreported case of warfarin-induced spontaneous elbow hemarthrosis, diagnosed by point-of-care ultrasound. On the basis of clinical and ultrasound findings arthrocentesis was deferred, and the patient was successfully treated with warfarin reversal and conservative care. Physical examination is unreliable for the detection of a joint effusion, and misdiagnosis and can lead to unnecessary investigation or resource use. Point-of-care ultrasound allows accurate, prompt, direct visualization of a joint effusion, and non-invasive confirmation of a hemarthrosis. Ultrasound can facilitate accurate diagnosis and characterization of joint effusions to improve the care of patients with coagulopathy.

No MeSH data available.


Related in: MedlinePlus