Poster Session : PS 0612 ; Others ; Successful Intracavitary tPA Treatment of Gastrocnemius Intramuscular Hematoma in a Patient Following Anticoagulant Therapy with Warfarin: Case Report = Poster Session : PS 0612 ; Others ; Successful Intracavitary tPA Treatment of Gastrocnemius Intramuscular Hematoma in a Patient Following Anticoagulant Therapy with Warfarin: Case Report

다국어 초록 (Multilingual Abstract)

Warfarin is an anticoagulant used in a variety of clinical indications and may rarely cause severe bleeding that can be life-threatening.Although intramuscular bleeding frequently occure secondary to trauma,it can be induced in cases that cause bleeding tendency.Hematoma is often treated with conventional methods.However, surgical decompression can also be applied.Case Report;A 71 year old male patient admitted to our clinic with increased skin temperature, swelling and redness on the right leg.Warfarin was the only drug in the present treatment that cause bleeding tendency.During the physical examination, swelling, skin redness, echymosis, decreased motility, pain with palpation and tenderness were deteceted on the gastrocnemius location of the right leg.There was no other fi nding in the rest systemic examination.Magnetic resonance imaging (MRI) of the right lower limb of the patient showed a mass lesion on posteromedial of right cruris, displacing the medial head of the gastrocnemius muscle laterally(fig 1).Considering the datas of the performed imaging methods and using an ultrasonography-assisted GF-multipurpose drainage pigtale catheter,intracavitary administration of 5 mg tPA and 25 cc serum sale mixture was performed.Subsequently the catheter was clamped for a 25-30 minutes time and spontaneous drainage occured. After the intervention,a compression bandage was done with elastic bandage in order to avoid reloading of the cavity.Ultrasonographic control was performed after each step of the intervention to check a possible presence of an organised hematoma and intervention went on till there was no liquid rest in the location of hematoma. The total recovery was also proved by magnetic resonance imaging after total clinical recovery was deteceted (fig2).This case report represents that the addition of fi brinolytics to the standard drainage techniques is a safe and effective therapy method in organised hematoma as well as abscess complicated with surgery.