title: Spontaneous calf hematoma in a patient with diabetic nephropathy receiving maintenance hemodialysis: A case report and review of the literature.
abstract: 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.
authors.affiliation: Department of Nephrology, Central South University, Changsha, Hunan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xiao
authors.affiliation: Department of Nephrology, Central South University, Changsha, Hunan, China.
authors.forename: Fengxia
authors.initials: F
authors.lastname: Ling
authors.affiliation: Radiology Department Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Lihua
authors.initials: L
authors.lastname: Tan
authors.affiliation: Radiology Department Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
authors.forename: Huabing
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Nephrology, Central South University, Changsha, Hunan, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Nephrology, Central South University, Changsha, Hunan, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Nephrology, Central South University, Changsha, Hunan, China.
authors.forename: Dang
authors.initials: D
authors.lastname: Tang
authors.affiliation: Department of Nephrology, Central South University, Changsha, Hunan, China.
authors.forename: Fuyou
authors.initials: F
authors.lastname: Liu
authors.affiliation: Departments of Pathology and Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Yashpal S
authors.initials: YS
authors.lastname: Kanwar
authors.affiliation: Department of Nephrology, Central South University, Changsha, Hunan, China.
authors.forename: Lin
authors.initials: L
authors.lastname: Sun
mesh_terms: D003928:Diabetic Nephropathies / Q000150:complications*; D006406:Hematoma / Q000209:etiology*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects*
keywords: Spontaneous calf hematoma; diabetic nephropathy; hemodialysis