PMC4887635_01
(a) Asymmetry can be observed between the two limbs due to swelling in the left thigh. P: proximal. D: distal. (b) The CT scan shows the presence of a perifemoral haematoma (indicated by the red arrow). The haematoma affects the vastus intermedius (VI) and a small image of active bleeding is visible in its interior. V: ventral. D: dorsal. VM: vastus medialis. VL: vastus lateralis. VI: vastus intermedius. SA: sartorius. FB: femoral biceps. SM: semimembranosus muscle.
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Physical examination revealed significant swelling in the anteromedial area of the right thigh at the level of the distal third (Figure 1(a)). Given the presence of haemodynamic instability and the increase in the diameter of the thigh, an urgent CT scan was performed, which showed a haematoma affecting the vastus intermedius and gluteus muscles of the patient's left leg and a small image of active bleeding in the interior (Figure 1(b)).
(a) A selective arteriography shows a point of active bleeding in a branch of the femoral artery at the level of the femoropopliteal junction (red arrow). (b) The image shows selective catheterisation of the bleeding branch (using Spongostan  particles) to carry out the correct occlusion of the branch. (c) Nuclear magnetic resonance (axial thigh T1) is performed after a month to monitor the patient's evolution. Subacute haematoma is observed in the distal third of the left thigh in the anterolateral compartment within the vastus intermedius muscle (VI). The haematoma did not present signs of spreading to other compartments or of affecting the adjacent femur. V: ventral. D: dorsal. VM: vastus medialis. VL: vastus lateralis. CT: quadriceps tendon. SA: sartorius. GM: gracilis muscle. FB: femoral biceps. SM: semimembranosus and semitendinosus muscle. Red arrow: subacute haematoma in resolution.
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After selective catheterisation of the bleeding branch of the artery, embolisation was performed with particles of Spongostan (Johnson & Johnson, Ferrosan Medical Services, Denmark) until occlusion was achieved with arteriographic monitoring (Figures 2(a) and 2(b)). The patient attended the outpatient service of the Orthopaedic Surgery and Traumatology unit, recovered total function of the limb, and resumed normal activities within a month of the contusion (Figure 2(c)).