rev bras hematol hemoter. 2 0 1 7;39(1):84–85
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Revista
Brasileira
de
Hematologia
e
Hemoterapia
Brazilian
Journal
of
Hematology
and
Hemotherapy
Images
in
Clinical
Hematology
Hemophilic
pseudotumor
–
a
rare
complication
Márcio
Luís
Duarte
a,b,∗,
Élcio
Roberto
Duarte
a,c,
Edgard
Brasil
Solorzano
caClinicaRadiológicaeEspecialidadesMédicasSãoGabriel,PraiaGrande,SP,Brazil
bWebImagem,SãoPaulo,SP,Brazil
cBrasilImagemMedicinaDiagnóstica,Santos,SP,Brazil
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Articlehistory:
Received8October2016 Accepted20October2016 Availableonline29December2016
A29-year-oldmalepatientpresentedwithprogressive defor-mity of hisleft elbow sincechildhood. He was constantly treatedwithfactorVIIIforseverehemophiliaA.Hestatedthat hehadnootherdiseasesandhadbeensubmittedtoany sur-geries.Atphysicalexamination,hepresentedwithrestricted elbowextension(Figure1A)andhadasimilardeformityofthe rightelbow.
Thepatientisnegativeforanti-factorVIIIinhibitor.A radio-graphdemonstrated clear deformityofthe distalhumerus with lytic lesions and edema of the surrounding soft tis-sues(Figure1B).Ultrasonographyidentifiedaheterogeneous,
∗ Correspondingauthorat:ClinicaRadiológicaeEspecialidadesMédicasSãoGabriel.RuaMihailoLukichMichel,94-Boqueirão,11701-370
PraiaGrande,SP,Brazil.Tel.:+5513981112799.
E-mailaddress:[email protected](M.L.Duarte).
ill-defined,ovalimagewithanadjacentboneirregularity with-out vascularizationbyDopplerultrasonography(Figure1C). Magnetic resonance imaging (MRI) demonstrated mor-phostructural deformity of elbow joint, with extensive depositionoflowsignalmaterialinthesynoviumand extra-osseoushemophiliacpseudotumor(Figure1D).
A hemophilic pseudotumor is the result of repeated episodes of bleeding at a bone fracture site or as a result of sub-periosteal hemorrhage or bleeding into soft tissue due to absence or lack of effective replacement treatment.1–3
http://dx.doi.org/10.1016/j.bjhh.2016.10.002
revbrashematolhemoter.2017;39(1):84–85
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Figure1–(A)Physicalexaminationoftheelbowdemonstratinglimitedjointextensionanddeformity.(B)Radiographywith notablebonedeformity,inparticularthedistalhumerus.(C)Ultrasonographydemonstratingheterogeneous,illdefined, ovaldeformitywithadjacentboneirregularitywithoutvascularizationaccordingtoaDopplerstudy.(D)ContrastT1FATSAT MRIwithsubtractionshowsmorphostructuraldeformityofelbowjoint,withextensivedepositionoflowsignalmaterialin
thesynovium(hemosiderin)andextra-osseoushemophiliacpseudotumormeasuring4.9×3.5×3.6cm(grayarrow).
Conflicts
of
interest
Theauthorsdeclarenoconflictofinterest.
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1.MahmudAA,BashirY,TauraMG,AdamuLH.Haemophilic pseudotumor:ararepathologicalentityinvolving5th metacarpalandassociatedtissues.SchJAppMedSci. 2015;3(4B):1707–11.
2.PakalaA,ThomasJ,CompP.Hemophilicpseudotumor:acase reportandreviewofliterature.IntJClinMed.2012;3:229–33. 3.StaffordJM,JamesTT,AllenAM,DixonLR.Hemophilic
