PMC6735189_01
Computed tomography scan of the abdomen and pelvis. Coronal (a) and axial (b) planes show asymmetrically enlarged right iliacus muscle (white arrows), consistent with hematoma. Sagittal plane of the hips: left unaffected hip (c) in comparison to the right hip (d), which showed right psoas muscle bleed after treatment of recombinant human factor VIIa and Factor Eight Inhibitor Bypassing Activity (FEIBA).
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Computed tomography (CT) scan of the abdomen showed a large right iliopsoas hematoma (Figures 1(a) and 1(b)). His hemoglobin continued to drop to 7.4 g/dL despite blood transfusions with increasing iliopsoas bleeding on a subsequent CT scan (Figures 1(c) and 1(d)).
Point-of-care musculoskeletal ultrasound and magnetic resonance imaging of suprapatellar recesses in the knees. Longitudinal MSKUS image (a) of the unaffected knee was compared to the affected knee (b), which showed semicompressible hypoechoic contents (white arrow) in the suprapatellar recess. T2-weighted (c) and T1-weighted (d) MRI showed hyperintense (white arrows), corresponding to blood clots. MSKUS, musculoskeletal ultrasound; MRI, magnetic resonance imaging.
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Conventional MRI to assess other abnormalities did not reveal acute injury and also confirmed absence of an effusion (Figure 2).
Timeline course of hospitalization stay and follow-up at the hematology clinic after a mechanical fall. High-dose corticosteroids were started on day 1 and tapered after one month, once eradication if the anti-FVIII antibody was achieved. Hgb, hemoglobin; PT, prothrombin time; aPTT, activated partial thromboplastin time; FVIII, Factor eight; BU, Bethesda units; rhFVIIa, activated recombinant human factor VII; RBC, red blood cell; FEIBA, Factor Eight Inhibitor Bypassing Activity; SNF, skilled nursing facility; POC MSKUS, point-of-care musculoskeletal ultrasound; MRI, magnetic resonance imaging.
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