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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 15  |  Issue : 2  |  Page : 306-307

Musculoskeletal manifestation of hemarthrosis as presentation of coagulopathy disorder in a child


Department of Radio Diagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Submission18-Jan-2020
Date of Decision30-Jan-2020
Date of Acceptance27-Feb-2020
Date of Web Publication21-Dec-2020

Correspondence Address:
Dr. Suresh Vasant Phatak
Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_13_20

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  Abstract 


Nontraumatic hemarthrosis is caused by variety of bleeding disorders which could be hereditary or acquired. Hereditary includes hemophilias and other coagulation factor deficiency disorder. Most of the coagulopathy patients present with uncontrolled spontaneous bleeding without any trauma. Here, we are presenting a case of 12-year-old boy who presented with stiffness and swelling of the right knee without any history of trauma.

Keywords: Coagulopathy, hemarthrosis, knee, sonography


How to cite this article:
Varma AD, Phatak SV, Jain SP, Mishra GV. Musculoskeletal manifestation of hemarthrosis as presentation of coagulopathy disorder in a child. J Datta Meghe Inst Med Sci Univ 2020;15:306-7

How to cite this URL:
Varma AD, Phatak SV, Jain SP, Mishra GV. Musculoskeletal manifestation of hemarthrosis as presentation of coagulopathy disorder in a child. J Datta Meghe Inst Med Sci Univ [serial online] 2020 [cited 2021 Jan 23];15:306-7. Available from: http://www.journaldmims.com/text.asp?2020/15/2/306/304240




  Introduction Top


Hemarthroses are the most common cause of progressive morbidity in coagulopathy disorder. Coagulopathy disorders start to manifest during childhood. The joint most commonly involved are knee elbow followed by ankles. To prevent long-term damage, early detection and early treatment is must. Further development of chronic synovitis leads to muscle wasting, stiffness and restriction of movement and complete destruction of joint. If not diagnosed and treated at right time leads to chronic deformity and destruction of joint.[1]


  Case Report Top


A 12-year-old boy presented to pediatric OPD with complaints of spontaneous pain, swelling, and stiffness in the right knee joint. On examination, joint was tender and had local rise in temperature. He gave a history of spontaneous uncontrollable bleeding from nose in the past. X-ray right knee was advised which showed soft-tissue swelling with no evidence of any joint destruction. Further on ultrasonography (USG) findings were as follows: A well-defined anechoic suprapatellar collection of fluid showed some debris within it and was compressible and could be displaced with the pressure of transducer. There was synovial thickening surrounding the effusion with minimal increased vascularity on Doppler examination. On doing laboratory investigations, his coagulation profile was as follows- prothrombin time was normal, while aPTT was raised suggesting coagulopathy disorder. On aspiration hemorrhagic fluid was obtained, confirming the diagnosis of hemarthrosis [Figure 1], [Figure 2], [Figure 3].
Figure 1: (a) X-ray anteroposterior view showing diffuse soft tissue edema, (b) X-ray lateral view showing soft tissue swelling surrounding knee joint , without any bony distruction

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Figure 2: Gray scale ultrasonography knee joint showing, fluid collection in suprapatellar bursa with debris within it

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Figure 3: Color Doppler of knee joint showing synovial thickening with increased vascularity

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  Discussion Top


Coagulopathies to be considered with normal prothrombin and abnormal aPTT are as follows factor VII, IX, XI, XII, HMWK, PK, fibrinogen deficiency. These factors deficiency leads to spontaneous bleeding in joint and manifests in childhood. Ultrasound is well-suited to evaluate acute joint pain or injury is useful in detecting effusion, fracture, and tendon or ligamentous rupture.[1] Knee ultrasound is performed using a high-frequency transducer. Images are obtained on anterior, lateral, medial, and posterior joint surfaces, with particularly attention to the site of maximal pain or swelling. Comparison with the unaffected extremity is useful to identify abnormalities.[2],[3] Ultrasound findings consistent with hemarthrosis are-the presence of a complex effusion, which can be compressed and displaced with the transducer. Hyperacute bleeding on USG demonstrate anechoic, simple fluid, or a uniformly echogenic appearance. Within minutes to hours, a hemarthrosis will layer out as a superficial hypoechoic layer of plasma with a dependent layer of erythrocytes. Intra-articular fractures demonstrate a 3-phase effusion on ultrasound, with a superficial layer of echogenic lipid, a central hypoechoic layer of plasma, and dependent red cells.[4],[5],[6],[7],[8],[9]


  Conclusion Top


To conclude ultrasound is an excellent modality for the diagnosis of musculoskeletal manifestation of coagulopathy disorders.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kidder W, Nguyen S, Larios J, Bergstrom J, Ceponis A, von Drygalski A. Point-of-care musculoskeletal ultrasound is critical for the diagnosis of hemarthroses, inflammation and soft tissue abnormalities in adult patients with painful haemophilic arthropathy. Haemophilia 2015;21:530-7.  Back to cited text no. 1
    
2.
Tagliafico AS, Bignotti B, Martinoli C. Elbow US: Anatomy, variants, and scanning technique. Radiology 2015;275:636-50.  Back to cited text no. 2
    
3.
Rabiner JE, Khine H, Avner JR, Friedman LM, Tsung JW. Accuracy of point-of-care ultrasonography for diagnosis of elbow fractures in children. Ann Emerg Med 2013;61:9-17.  Back to cited text no. 3
    
4.
Zukotynski K, Jarrin J, Babyn PS, Carcao M, Pazmino-Canizares J, Stain AM, et al. Sonography for assessment of haemophilic arthropathy in children: A systematic protocol. Haemophilia 2007;13:293-304.  Back to cited text no. 4
    
5.
Wankhade PA, Patond SK, Tirpude BH. Roentgenographic Evaluation of Bones at Wrist Joint for osteological Maturity for Academic and Judicial Intrest. Indian J Forensic Med Toxicol 2019;13:131-6. Available from: https://doi.org/10.5958/0973-9130.2019.00275.5. [Last accessed on 2020 Jan 04].  Back to cited text no. 5
    
6.
Kinyoki DK, Ross JM, Lazzar-Atwood A, Munro SB, Schaeffer LE, Abbasalizad-Farhangi M, et al. Mapping Local Patterns of Childhood Overweight and Wasting in Low- and Middle-Income Countries between 2000 and 2017. Nat Med 2020. Available from: https://doi.org/10.1038/s41591-020-0807-6. [Last accessed on 2020 Jan 04].  Back to cited text no. 6
    
7.
Rohan S, Panda P, Dungarwal M, Gupta S, Kawde P. Idiopathic Charcot's Arthropathy of Ankle Joint: A Rare Case. J Clin Diagn Res 2019;13:RD03-5. Available from: https://doi.org/10.7860/JCDR/2019/40518.12663. [Last accessed on 2020 Jan 04].  Back to cited text no. 7
    
8.
John S, Kar S, Kumar K, Mishra KK. Influence of Parenting Style on Behavioural Patterns in Children. Indian J Psychiatry 61;9:S410.  Back to cited text no. 8
    
9.
Maryada SR, Dhaniwala NS. Outcome of Surgically Managed Diaphyseal Fractures in Children- A Prospective Study. J Evol Med Dent Sci 2020;9:393-7. Available from: https://doi.org/10.14260/jemds/2020/90. [Last accessed on 2020 Jan 04].  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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