J Korean Orthop Assoc.  2019 Apr;54(2):177-181. 10.4055/jkoa.2019.54.2.177.

Acute Compartment Syndrome after Anticoagulant Therapy to Misdiagnosed Deep Vein Thrombosis

• Hwang SH
• Jeon HS
• Woo YK
• Lim ST

• KMID: 2444784
• DOI: http://doi.org/10.4055/jkoa.2019.54.2.177

Abstract

Acute compartment syndrome, which is an orthopedic emergency, induces irreversible tissue necrosis by increasing the compartment pressure. In serious cases, this event may result in functional impairment, loss of the lower limb, and death by renal failure. When the patient initially presents with pain and swelling that are similar to deep vein thrombosis, a differential diagnosis between the two diseases is very critical. The authors encountered a case of acute compartment syndrome after anticoagulant therapy in a patient presenting with painful swelling of the left leg following a massage that was initially misdiagnosed as deep vein thrombosis. A fasciotomy was performed on this case with satisfactory results. This paper reports this case with a review of the relevant literature.

Keyword

compartment syndrome; deep vein thrombosis; anticoagulant therapy; fasciotomy

MeSH Terms

Compartment Syndromes*
Diagnosis, Differential
Emergencies
Humans
Leg
Lower Extremity
Massage
Necrosis
Orthopedics
Renal Insufficiency
Venous Thrombosis*

Figure

• 

  Figure 1 Initial photograph of both lower legs. There was no significant difference in the swelling in both legs.

• 

  Figure 2 Axial images (A, B) and 3-dimensional reconstruction image (C) of computed tomography venogram show a poorly visible posterior tibial and popliteal vein (thick short white arrows) with a heterogeneous density of subcutaneous soft tissue, small amount of intramuscular hemorrhage, and edema of the deep soft tissue (long thin white arrows).

• 

  Figure 3 T2-weighted magnetic resonance axial image (A) and sagittal image (B) show multiloculated fluid collection, suggesting an extensive large hematoma compressing the adjacent vessels between the soleus and gastrocnemius muscle.

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  Figure 4 Algorithm for the diagnosis and treatment of acute compartment syndrome of lower leg after tibial fracture. Cited from the article of Bourne and Rorabeck (Clin Orthop Relat Res. 1989;240:97-104).5)

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  Figure 5 (A) Extensive hematoma in the posterior compartment between the soleus and gastrocnemius muscles after fasciotomy can be seen. (B) After removing the hematoma of the posterior compartment, markedly swollen muscles were observed.

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