Pseudoaneurysm of the Calf After Electromyography: Sonographic and CT Angiographic Diagnosis

Rosioreanu, Alex; Dickson, Asante M.; Lypen, Steven; Katz, Douglas S.

doi:10.2214/ajr.185.1.01850282

Cited by 14 publications

(11 citation statements)

References 3 publications

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“…Despite this theoretical risk, the magnitude of the risk has been shown to be extremely low (Lynch S, et al, Muscle & Nerve, in press). There are only a few reports of paraspinal hematoma, calf hematoma, and calf artery pseudoaneurysm development following needle EMG in patients on anticoagulation 9, 27, 46. In a survey of 47 EMG laboratories in the United States, 9% of laboratories reported experiencing at least 1 episode of bleeding complication requiring medical or surgical intervention due to needle EMG 27.…”

Section: Potential Complications During Needle Electromyographymentioning

confidence: 99%

Needle electromyography

2009

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Physiologic assessment of diseases of the motor unit from the anterior horn cells to the muscles relies on a combination of needle electromyography (EMG) and nerve conduction studies (NCS). Both require a unique combination of knowledge of peripheral nervous system anatomy, physiology, pathophysiology, diseases, techniques, and electricity is necessary. Successful, high-quality, reproducible EMG depends on the skills of a clinician in patient interaction during the physical insertion and movement of the needle while recording the electrical signals. These must be combined with the skill of analyzing electric signals recorded from muscle by auditory pattern recognition and semiquantitation.1052 This monograph reviews the techniques of needle EMG and waveform analysis and describes the types of EMG waveforms recorded during needle EMG.

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Section: Potential Complications During Needle Electromyographymentioning

confidence: 99%

Needle electromyography

2009

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“…6 A computerized axial tomography scan showed a hematoma in the right subcutaneous tissue without evidence of retroperitoneal hematoma. 6 Rosioreanu et al 13 published a case report of an 81-year-old woman with atrial fibrillation who was taking warfarin. She underwent EMG for evaluation of peripheral neuropathy and spinal stenosis.…”

Section: Discussionmentioning

confidence: 99%

Complications of needle electromyography: Hematoma risk and correlation with anticoagulation and antiplatelet therapy

et al. 2008

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Electromyography (EMG) is considered a relatively safe procedure based primarily on clinical experience. Literature review reveals few reported complications from bleeding or hematoma formation. No evidence-based guidelines exist for EMG procedures in patients who are taking anticoagulant or antiplatelet medications. The purpose of this study was to determine if patients taking anticoagulant or antiplatelet agents exhibit an increased risk of hematoma formation after routine needle EMG of the tibialis anterior muscle when compared to controls. Study subjects underwent routine needle EMG of the tibialis anterior muscle followed by ultrasound examination to evaluate for the presence of hematoma formation. A mean of 30.8 min elapsed between needle insertion and ultrasound evaluation. A total of 101 patients who were taking warfarin were studied. They had International Normalized Ratio (INR) values at or above 1.5, and two were found to have small, subclinical hematomas. Of 57 patients taking clopidogrel and/or aspirin, 1 was found to have a small, subclinical hematoma. In the control group (51 patients taking neither class of medication), no hematomas were found on ultrasound. This study suggests that hematoma formation from a standard needle EMG is rare. In addition, hematoma formation in our study group of patients on anticoagulant or antiplatelet medications was also uncommon, and no patients with documented hematomas experienced symptoms. These findings should be considered when determining the feasibility of electrodiagnostic evaluation of patients who are taking anticoagulant or antiplatelet medications.

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“…Serious hemorrhagic complications of needle EMG appear to be rare events in anticoagulated patients in the medical literature. The two reported cases of bleeding complications in anticoagulated patients includes an 81‐year‐old woman who presented 16 days after an EMG with a calf hematoma and calf artery pseudoaneurysm 8. Her INR at the time of the EMG had been 2.5.…”

Section: Discussionmentioning

confidence: 99%

“…Reports of hemorrhagic complications are not clearly more frequent in the paraspinal muscle location. Of the four cases in the literature of symptomatic EMG‐related hematomas (again excluding the case confounded by trauma3), two involved the paraspinal muscles,4, 5 and two involved the leg 6, 8. Furthermore, one of the two leg hematomas required surgical intervention, whereas both paraspinal hematomas were managed medically.…”

Section: Discussionmentioning

confidence: 99%

“…There are only two case reports in the literature of symptomatic hemorrhage related to needle EMG of anticoagulated patients 4, 8. Based on this type of limited data, various strategies have been acknowledged including complete avoidance of all needle EMG,1 restrictions based on location of needle insertion,1, 2 temporary interruption of anticoagulation,6 and use of small gauge needles 1.…”

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Survey of electrodiagnostic laboratories regarding hemorrhagic complications from needle electromyography

et al. 2006

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Little is known about the complications of needle electromyography (EMG) performed on anticoagulated patients, and no guidelines exist regarding its performance. We conducted an anonymous survey of academic EMG laboratories in the U.S. to understand current practices and complications with regard to anticoagulated patients and those receiving antiplatelet medications. Forty-seven (78%) of 60 EMG laboratories responded to the survey. Four laboratories (9%) reported at least one hemorrhagic complication requiring medical or surgical intervention in an anticoagulated patient, whereas none reported a hemorrhagic complication in patients receiving antiplatelet medications. Ten (21%) reported willingness to evaluate cranial, paraspinal, and all limb muscles in anticoagulated patients. This survey suggests that hemorrhagic complications from needle EMG of anticoagulated patients are rare. It also suggests that needle EMG of patients receiving antiplatelet therapy is not associated with increased reports of hemorrhagic complications.

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Pseudoaneurysm of the Calf After Electromyography: Sonographic and CT Angiographic Diagnosis

Cited by 14 publications

References 3 publications

Needle electromyography

Needle electromyography

Complications of needle electromyography: Hematoma risk and correlation with anticoagulation and antiplatelet therapy

Survey of electrodiagnostic laboratories regarding hemorrhagic complications from needle electromyography

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