Leg Swelling Caused by Heterotopic Ossification Mimicking Deep Vein Thrombosis in a Paraplegic Patient

Abstract

Leg swelling in patients with paraplegia due to spinal cord injury (SCI) occurs for various reasons, including heterotopic ossification (HO), deep vein thrombosis (DVT), fracture, or cellulitis. The clinical presentations of these conditions may overlap in part or in whole and it may occasionally be difficult to distinguish. Of these conditions, DVT and subsequent pulmonary embolism remain significant causes of morbidity and mortality in patients with SCI. Therefore, a prompt diagnostic work-up, particularly for DVT, is essential in patients with SCI, who present with leg swelling. Here, we report a case of leg swelling in a paraplegic patient, resulting from HO mimicking DVT and discuss the differential diagnosis.

Massive Edema of the Lower Limbs in Patients after Spinal Cord Injury—One Picture, Different Diagnoses

“…A case of HO imitating DVT was also described by Bang [ 1 ] in a 35 year old patient with tetraplegia after SCI, who developed edema 1 month after the injury and had redness and increased calf temperature, normal D-dimer levels, and slightly elevated APL at 140 U/L (norm to 129 U/L). A DUS was performed, which excluded DVT, and computed tomography venography (CTV) visualized HO in the anteromedial part of the thigh, which was compressing the veins.…”

“…In one patient, several causes of edema may occur in a short period of time, which require radically different treatment approaches. Lower-limb DVT occurs most often in the acute period up to the third month after injury, although it can also be observed in the chronic period [ 1 , 3 , 4 , 5 ]. The most important laboratory test used in the diagnosis of DVT is the D-dimer test, which is 87–100% sensitive but not very specific (approximately 55%) [ 6 , 7 , 8 , 9 ].…”

“…Edema of the lower limbs frequently occurs in this group of patients. It may be caused by immobilization, as well as venous and lymphatic stasis, but it can also be the result of more serious complications such as deep vein thrombosis (DVT), heterotopic ossification (HO), intramuscular hematomas (IHs), limb fractures, or cellulite [ 1 , 2 ]. Due to the abnormal or disturbed feeling of pain in patients after SCI, diagnosis of edema based on clinical examination is difficult.…”

Heterotopic ossification with femoral vein compression mimicking deep vein thrombosis

“…We performed venography before and after the surgery and radiation therapy, which has not been reported previously. 1,2,11 The first venogram showed right femoral vein stenosis because of external compression. During the second venography, we performed a balloon angioplasty because the symptoms did not improve immediately after the surgery.…”