Low-molecular-weight heparin (LMWH) has been considered superior to unfractionated heparin in several facets such as more effective anticoagulant, more predictable bioavailability, and less bleeding complications. We report two cases of LMWH, enoxaparin-induced spontaneous intramuscular hematoma with compartment syndrome of the lower extremity in patients with cardiac problems. The patients were treated with enoxaparin (LMWH) as bridging anticoagulation before use of warfarin due to cardiac problems. At the average 3 days of enoxaparin treatment, large and painful swelling was noticed in the lower extremities without intramuscular injection or trauma. The patients were diagnosed as having compartment syndrome with large intramuscular hematoma by CT. The patients underwent immediate fasciotomy and hematoma evacuation, and recovered without any complications.
Intramuscular hematoma in inner pelvic wall may not be a common problem for orthopaedic surgeons. It may be associated with fractures of pelvic bone, or bleeding tendency from various reasons.Usually these hematomae are managed conservatively because they have no harmful effect to the patient, their position makes it difficult to approach. Furthermore, the diagnosis of the hematomae is not simple, so suspicion is important for its diagnosis.
We experienced one case of delayed intramuscular hematoma in iliacus muscle in a 16-year old boy who had suffered blunt trauma to the pelvic area five weeks before. MRI had a significant role in the diagnosis of the hematoma. After evacuation of the hematoma, the patient recovered to normal status. Concerning about its unusual course and diagnostic significances of MRI, we report this case after reviewing of the Iiteratures.
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Muscular Injury of Iliacus and Gluteus Maximus after Mountain Climbing Ho Seung Jeon, Young Kyun Woo, Suk Ha Hwang, Seung Pyo Suh, Joon Kyung Lee The Korean Journal of Sports Medicine.2014; 32(1): 65. CrossRef