Spontaneous calf hematoma in a patient with diabetic nephropathy receiving maintenance hemodialysis: A case report and review of the literature
Spontaneous calf hematoma in a patient with diabetic nephropathy receiving maintenance hemodialysis: A case report and review of the literature
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DOI：
10.1111/hdi.12246
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发表时间：
2015-10-01
影响因子：
1.3
通讯作者：
Sun, Lin
中科院分区：
文献类型：
--
作者：
Xiao, Li;Ling, Fengxia;Sun, Lin
我们报告一位52岁的糖尿病肾病患者，接受以低分子量肝素（LMWH）作为抗凝剂的维持性血液透析（HD）2年。患者出现右下肢疼痛伴行走困难2个月，无出血倾向或外伤史。体格检查发现他的右下肢明显肿胀和压痛。经超音波及磁振造影诊断，小腿血肿被诊断为静脉血栓形成。无肝素HD治疗后，肿胀消退，疼痛消退，随访MRI显示血肿完全溶解。然而，2个月后右上肢出现类似症状复发，无任何诱因，仅接受低分子肝素HD治疗，上述治疗后症状消退。这表明，HD患者，尤其是伴有肢体血肿的糖尿病肾病患者，应注意自发性出血的发展，这些自发性出血可通过影像学检查（如MRI）进行鉴别诊断，并可通过无肝素HD进行有效治疗。
We report the outcome of a 52-year-old patient with diabetic nephropathy and receiving maintenance hemodialysis (HD) using low molecular weight heparin (LMWH) as an anticoagulant for 2 years. He presented right lower limb pain accompanied with difficulty in walking for 2 months, and had no history of bleeding tendency or trauma. Physical examination revealed marked swelling and tenderness on his right lower limb. By ultrasound and magnetic resonance imaging (MRI) diagnoses, the calf hematoma was diagnosed and identified with venous thrombosis. Following treatment with heparin-free HD, the swelling regressed and pain subsided, and a follow-up MRI showed complete dissolution of hematoma. However, similar symptoms recurred in the right upper limb after 2 months without any predisposition, he was just placed on HD with LMWH, and symptoms regressed following the aforementioned therapy. This suggests that HD patients, especially with diabetic nephropathy having extremity hematoma, should be watched for the development of spontaneous hemorrhage that can be differentially diagnosed by imaging tests, such as MRI, and can be effectively treated with heparin-free HD.