warfarin and Bone-Diseases

A fifty-year-old woman with developmental dysplasia of the hip underwent total hip arhtroplasty, and subsequently developed recurrent venous thrombophilia of the lower extremities. Hematological examination revealed an inherited disorder of blood coagulation (homozygous mutation of the 5,10-methylenetetrahydrofolate reductase gene) and therefore longterm Warfarin anticoagulation therapy was started. A year later she was diagnosed with a large pelvic posthemorrhagic pseudocyst (hematoma) located below the musculus iliacus and adhering to bone in the region of posterior acetabulum. The condition was complicated by usuration and focal osteolysis of the adjacent pelvic bone. Histological examination of the hematoma showed characteristics of an unusual pseudoxanthoma mimicking Erdheim-Chester disease. The differential diagnosis of histological findings is discussed and recent relevant literature is reviewed.

Topics: Anticoagulants; Arthroplasty, Replacement, Hip; Blood Coagulation Disorders, Inherited; Bone Diseases; Diagnosis, Differential; Erdheim-Chester Disease; Female; Hematoma; Hip Dislocation, Congenital; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Pelvic Bones; Warfarin

Chronic expanding hematoma is a rare presentation of a hematoma characterized by a persistent increase in size for more than a month after the initial hemorrhage. We present a 65-year-old man with a chronic expanding hematoma in his ilium who was receiving anticoagulant treatment. The patient had a delayed manifestation of a femoral neuropathy with massive bone destruction. 2-Deoxy-[18F]fluoro-D: -glucose (FDG) positron emission tomography (PET) imaging revealed an increased uptake in the rim of the mass in images acquired 1 h after FDG injection. FDG-PET scans were performed using a dedicated PET scanner (HeadtomeV/SET2400 W, Shimadzu, Kyoto, Japan), and the PET data for the most metabolically active region of interest (ROI) were analyzed. The maximum standardized uptake value (SUVmax) was set to a cut-off point of 3.0 to distinguish between benign and malignant lesions. The SUVmax of the patient's lesion was 3.10, suggesting a malignant lesion. The characteristics of FDG-PET images of chronic expanding hematomas, including the uptake of FDG in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall in mimicking a sarcoma.

Topics: Aged; Anticoagulants; Bone Diseases; Chronic Disease; Fluorodeoxyglucose F18; Hematoma; Humans; Ilium; Male; Positron-Emission Tomography; Radiopharmaceuticals; Warfarin

Topics: Abnormalities, Drug-Induced; Abortion, Spontaneous; Anticoagulants; Bone Diseases; Female; Heart Valve Diseases; Hemorrhage; Heparin; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Thromboembolism; Warfarin

Topics: Animals; Anticoagulants; Bone Diseases; Drug Interactions; Horse Diseases; Horses; Tarsal Bones; Warfarin