Abstract
Abstract An 85-year-old male presented with a hip fracture following an accidental fall. His background included chronic kidney disease, hypertension, high cholesterol, and type 2 diabetes mellitus. He underwent a intramedullary nail for a subtrochanteric fracture. Post-op he had 4 units of red blood cells for post-op anaemia. Despite multiple transfusions, his haemoglobin levels gradually decreased and there was no evidence of visible bleeding from the wound or other sites. He complained of persistent swelling and pain limiting his mobility. Pelvic x-rays revealed stable fixation. Patient developed a deep vein thrombosis and was started on low molecular weight heparin. Further acute drop in his haemoglobin prompted for an ultrasound of his hip, which identified an intramuscular haematoma. This was confirmed on a CT angiogram which revealed an active haemorrhage within the right vastus intermedius muscle with associated haematoma, which appeared to arise from a branch of the profunda femoris. The patient underwent coil embolization under radiological guidance which successfully achieved complete haemostasis. It was also revealed that he had a large pseudoaneurysm arising from the descending branch of the right lateral circumflex artery. Post-procedure his haemoglobin remained stable, pain controlled adequately and tolerating anticoagulation without further drop in haemoglobin. Furthermore, his mobility improved and he was deemed medically fit to be discharged to rehabilitation. Although pseudoaneurysms are very rare, persistent drop in haemoglobin, pain, swelling and poor a stable fixation of an intrameduallary nail should raise suspicion of a haematoma, and requires further investigations with a CT angiogram.
Published Version
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