Disclosures: Michelle H. Lee, MD: No financial relationships or conflicts of interest

Case Diagnosis: 42-year-old female with subcutaneous hematoma found to have left upper extremity DVT

Case Description: Patient has a history of spontaneous left forearm swelling and ecchymosis, leading to a diagnosis of cellulitis based on MRI findings and a 7-day inpatient IV antibiotics course in 2019. 10 months later, she was referred to the clinic with left forearm pain after lightly hitting her hand against the wall. One week later, she developed significant swelling with ecchymosis, similar to the presentation in 2019. Diagnostic ultrasound and MRI showed intact tendons but marked edema. Given her cellulitis history and rapidly progressive symptoms, we decided to aspirate the fluid collection and transfer her to ED for empiric antibiotics. Patient was discharged from ED overnight after fluid analysis findings consistent with hematoma and all other workups negative for infection. She returned to the clinic with persistent symptoms 2 weeks later. Doppler ultrasound was ordered and showed a brachial vein thrombus.

Setting: Tertiary center sports clinicAssessment/

Results: After 3 months of anticoagulation, her symptoms resolved and a repeat ultrasound showed thrombus resolution. With negative hematologic workups, Hematology suspects the DVT was provoked by forearm swelling and inflammation.

Discussion: Upper extremity DVT is potentially life-threatening and can be overlooked in the musculoskeletal clinic. This patient presented with a zero Caprini VTE risk score but marked edema disproportional to the mild trauma. It is unclear whether the forearm swelling had led to the thrombus, or if her swelling was the result of the DVT. It is worth noting that the pathophysiology of an encapsulated subcutaneous hematoma formation is similar to that of an intravascular thrombus.

Conclusion: When evaluating subcutaneous fluid collections, vascular etiologies should be considered in addition to the more common musculoskeletal conditions seen at the sports clinic setting. Presentation of a hematoma further suggests evaluation for possible thrombus.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/subcutaneous-hematoma-and-upper-extremity-dvt-seen-in-sports-clinic-a-case-report/