Spontaneous Adductor Hematoma in a 75-Year-Old Male With Acute Thigh Bruises

TL;DR

An elderly patient on anticoagulation therapy developed a spontaneous thigh hematoma, requiring careful management to balance bleeding risks and clot prevention.

Contribution

This case highlights the challenges of managing intramuscular hematomas in patients with a history of blood clots and anticoagulation therapy.

Findings

The patient's ecchymoses rapidly expanded, leading to an intramuscular hematoma.

Discontinuation of anticoagulation and non-surgical monitoring stabilized the hematoma.

Multidisciplinary care was essential in managing the patient's condition.

Abstract

Patients with a history of blood clots are commonly placed on anticoagulation therapy, but a common adverse effect of this therapy is hemorrhage. Our patient with a history of left ventricle thrombus in a free-standing inpatient rehabilitation hospital had ecchymoses that expanded over a large portion of the posterior thigh in one day. The rapid expansion of the ecchymoses coupled with a decline in hemoglobin levels prompted an immediate evaluation that showed an intramuscular hematoma. With hemoglobin levels dropping significantly, the patient was then transferred to the emergency department for higher levels of care. A multidisciplinary team of vascular surgery and electrophysiology physicians decided to discontinue anticoagulation and monitor the hematoma with serial compartment checks. The hematoma had stabilized throughout the hospital stay without surgical intervention. This case will discuss the difficulty of managing a patient with a history of previous blood clots with an adductor magnus hematoma in the setting of concurrent iatrogenic anticoagulation. Furthermore, we will review the current management and evaluation of intramuscular hematomas.

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