Lumbar synovial joint hematoma in a patient on anticoagulation treatment

Spine (Phila Pa 1976). 2007 Apr 20;32(9):E300-2. doi: 10.1097/01.brs.0000261410.07412.83.

Abstract

Study design: Case report.

Objective: To describe a case of spinal epidural hematoma arising from the synovial joint due to anticoagulation therapy.

Summary of background data: Spontaneous spinal epidural hematoma is a rarity in the literature with a variety of etiologies. In 1 study, it was reported to originate from a synovial joint due to osteoarthritis of the joint.

Methods: A case of hematoma of the lumber synovial joint is presented.

Results: A 67-year-old man who was on anticoagulation therapy presented with progressive neurologic symptoms in the right lower limb. Magnetic resonance imaging scan revealed what was thought to be a L4-L5 synovial joint cyst. During surgery, it was proven to be an epidural hematoma originating from the synovial joint. Microscopic examination confirmed the diagnosis and excluded the possibility of spinal synovial cyst. After spinal decompression, neurologic symptoms improved completely in 2 weeks.

Conclusions: This is the first report of a synovial cyst hematoma due to anticoagulation therapy. Its magnetic resonance imaging features can be similar to synovial cyst, especially when it is hemorrhagic. Spinal decompression was the definitive treatment.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anticoagulants / adverse effects*
  • Anticoagulants / therapeutic use
  • Cardiovascular Diseases / prevention & control
  • Diagnosis, Differential
  • Hematoma / chemically induced*
  • Hematoma / diagnosis
  • Hematoma / pathology
  • Hematoma, Epidural, Spinal / chemically induced*
  • Hematoma, Epidural, Spinal / diagnosis
  • Hematoma, Epidural, Spinal / pathology
  • Humans
  • Lumbar Vertebrae*
  • Magnetic Resonance Imaging
  • Male
  • Synovial Cyst / diagnosis
  • Synovial Cyst / pathology
  • Warfarin / adverse effects*
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Warfarin