E. Carlos Rodriguez-Merchan* Pages 1 - 7 ( 7 )
Prevention is essential for avoiding the complications of muscle hematomas (compartment syndrome, pseudotumous and peripheral nerve lesions) in hemophilic patients. This is achieved through early diagnosis of muscle hematomas and proper long-term hematological treatment until they have resolved (confirmed by image studies). Ultrasound-guided percutaneous drainage could be beneficial in terms of achieving better and faster symptom relief. Acute compartment syndrome (ACS) requires emergency surgical treatment (decompression fasciotomy). As for pseudotumor, biopsy will help us confirm the diagnosis and rule out true tumors (chondrosarcoma, liposarcoma, synovial sarcoma) that sometimes mimic hemophilic pseudotumour. Surgical removal of hemophilic pseudotumor is the best solution. As alternatives, there are curettage and filling with cancellous bone and radiotherapy (when surgery is contraindicated). Preoperative arterial embolization (ideally 2 weeks before surgery) helps control intraoperative bleeding during surgery for giant pelvic pseudotumor. Peripheral nerve injuries, which are rare, almost always occur due to compression of hematomas in the vicinity. In most cases, they usually resolve with hematological treatment only. If such treatment fails, surgery would be indicated.
Antifungal protein, Candida albicans, Colletotrichum sp. DM-06, endophytic fungus, extracellular protein, pathogenic fungus, Hemophilia, muscle hematomas, pseudotumors, acute compartment syndrome, peripheral nerve injuries, diagnosis, treatment.
Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid