Disclosures: Olumide Sokunbi, MD: No financial relationships or conflicts of interest

Case Diagnosis: 67-year-old woman with right adductor pain and 57-year-old woman with right knee pain, both found to have hematomas

Case Description or Program Description: Patient A is a 67-year-old female with breast cancer who presented to hospital with vomiting, was diagnosed with COVID, and developed encephalopathy. During inpatient rehabilitation (IPR), she developed right adductor muscle pain. Patient B is a 57-year-old female with history of multiple aneurysms, who presented to hospital with COVID complicated by gastrointestinal bleed. She required intubation due to altered mental status. During IPR, she developed severe right knee pain.

Setting: Inpatient rehabilitation hospital

Assessment/Results: Patient A had increase in right thigh circumference with negative bilateral lower extremity Dopplers. Her hemoglobin was 5.4. CT right lower extremity without contrast revealed a large hematoma in left mid thigh. Surgery recommended wrapping with ACE bandage. Patient B was found unresponsive with pulse and significant hypotension. Her hemoglobin dropped to 6.1. CT abdomen and pelvis revealed large retroperitoneal bleed of right iliopsoas and iliacus. She underwent interventional radiology guided embolization of lumbar artery.

Discussion (relevance): Patient A had pancytopenia due to cancer. Her hemoglobin was 8.5 prior to the discovery of the hematoma. Her underlying comorbidities played a role in her rapid presentation of hematoma.

Patient B was found to be unresponsive at home prior to acute care hospital admission. Etiology was unclear. Her decreased mental status may have complicated the interpretation of musculoskeletal pain. She reported 10/10 knee pain but had a benign exam.

Conclusions: Musculoskeletal complaints are common, especially in IPR setting. As physiatrists, we must keep anemia from hematomas, associated with high mortality, on the differential diagnosis for lower extremity musculoskeletal pain. Frequent lab monitoring and physical exams are essential in timely diagnosis and treatment of hematomas.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/hematoma-presenting-as-lower-extremity-pain-a-case-series/