Complications of Muscle Hematomas in Hemophilia

Abstract

: Prevention is essential for avoiding the complications of muscle hematomas (compartment syndrome, pseudotumous and peripheral nerve lesions) in hemophilic patients. This is achieved through early diagnosis of muscle hematomas and proper long-term hematological treatment until they have resolved (confirmed by image studies). Ultrasound-guided percutaneous drainage could be beneficial in terms of achieving better and faster symptom relief. Acute compartment syndrome (ACS) requires emergency surgical treatment (decompression fasciotomy). As for pseudotumor, biopsy will help us confirm the diagnosis and rule out true tumors (chondrosarcoma, liposarcoma, synovial sarcoma) that sometimes mimic hemophilic pseudotumour. Surgical removal of hemophilic pseudotumor is the best solution. As alternatives, there are curettage and filling with cancellous bone and radiotherapy (when surgery is contraindicated). Preoperative arterial embolization (ideally 2 weeks before surgery) helps control intraoperative bleeding during surgery for giant pelvic pseudotumor. Peripheral nerve injuries, which are rare, almost always occur due to compression of hematomas in the vicinity. In most cases, they usually resolve with hematological treatment only. If such treatment fails, surgery would be indicated.

Clinical characteristics and surgical treatment of haemophilic pseudotumor: A retrospective analysis of thirty‐four patients

“…HPT is an expanding destructive encapsulated haematoma. Prevention is essential to avoid complications in patients with haemophilia 15,27,28 . In fact, this goal can be achieved by preventing muscle haematoma and adequate and long‐term haematological treatment of muscle haematoma in cases the condition appears.…”

“…Therapeutic arterial embolization of HPT should be considered in lesions of large size, especially in HPT at the pelvic region, as it may effectively reduce its size and decrease the risk of bleeding complications during surgery 36 . Many authors suggested that embolization be performed, as a preparatory procedure, at best about 2 weeks prior to surgery 15,20,27 …”

“…Diagnosis of HPT is usually based on clinical and radiographic findings. Biopsy, required for a definite diagnosis of HPT, helps us eliminate malignant or benign lesions that sometimes mimic HPT 12‐15 . However, preoperative biopsy is regarded as contraindicated due to the increased risks of haemorrhage, infection or other severe complications 5,16 …”

The evolution of physiotherapy in the multidisciplinary management of persons with haemophilia (PWH): A scoping review

“…They can be subdivided into subcutaneous, subperiosteal or more frequently muscular. Muscle haemorrhages occur in approximately 10%–20% of PWH and account for 10%–15% of all haemorrhagic events, causing motion limitations, disability, and impaired quality of life 11,12 . Muscle bleeding increases the risks of developing the compartment syndrome, cysts and pseudotumours.…”