Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

LETTER TO EDITOR
Year
: 2001  |  Volume : 11  |  Issue : 3  |  Page : 152--153

Spontaneous mediastinal hematoma in a case of hemophilia


F Nelson, P Kathiresan, A Swaminathan, MK Sivakolunthu 
 Department of Radiology, Government Rajaji Hospital, Madurai, Tamil Nadu, India

Correspondence Address:
F Nelson
Department of Radiology, Government Rajaji Hospital, Madurai, Tamil Nadu
India




How to cite this article:
Nelson F, Kathiresan P, Swaminathan A, Sivakolunthu M K. Spontaneous mediastinal hematoma in a case of hemophilia.Indian J Radiol Imaging 2001;11:152-153


How to cite this URL:
Nelson F, Kathiresan P, Swaminathan A, Sivakolunthu M K. Spontaneous mediastinal hematoma in a case of hemophilia. Indian J Radiol Imaging [serial online] 2001 [cited 2020 Feb 16 ];11:152-153
Available from: http://www.ijri.org/text.asp?2001/11/3/152/28395


Full Text

We would like to report a rare case of spontaneous mediastinal hematoma in a hereditary clotting factor deficiency disorder.

A fifteen-years-old boy already known to have hemophilia presented with complaints of cough and difficulty in breathing and swallowing for two days. A plain radiograph of the chest revealed bilateral widening of the superior mediastinum with obscuration of aortic knuckle [Figure 1]. USG showed hyperechoic areas in the superior thyroid gland.

Axial CT sections showed diffuse hyperdense areas with an attenuation value of around 70 HU in the superior mediastinum causing compression of the superior vena cava and innominate veins [Figure 2],[Figure 3]. The hyperdense areas are seen to extend into the anterior cervical space of the neck [Figure 4].

A diagnosis of spontaneous mediastinal hematoma was made and the patient was treated with replacement therapy with factor VIII concentrate. The patient recovered well and a repeat chest radiographs revealed reduction in the size of the mediastinal widening.

The usual presentations of hereditary clotting factor deficiency disorders are hemarthrosis, intramuscular or subcutaneous hematoma, epistaxis, hematuria and life-threatening CNS hemorrhage. This unusual presentation of mediastinal hemorrhage in a hemophiliac can be diagnosed by bilateral widening of the superior mediastinum with obscuration of the aortic knuckle on plain radiographs, hyperechoic areas in the superior mediastinum on USG and diffuse hyperdense areas in the mediastinum on CT. Management is mainly conservative with replacement therapy of factor VIII concentrate.[3]

References

1Wooding JH, Loh FK, Kryscio RJ. Mediastinal hemorrhage: an evaluation of radiographic manifestation. Radiology 1994; 151:15-21
2Horky JK, Chaloupka JC, Kirkwood JR et al . Spontaneous mediastinal hematoma - diagnostic imaging features of a rare clinical entity. Emergency Radiol 1997; 4:101
3Kuz'min DS. X-ray studies in the diagnosis of complications of hemophilia. Khirurgiia (Mosk) 1972; 48: 42-46