Spontaneous elbow hemarthrosis identified by point-of-care ultrasound

Abstract

Traumatic or spontaneous hemarthroses are an important cause of joint effusions, and can complicate innate or acquired coagulopathies. The elbow is an unusual location for a spontaneous hemarthrosis; we describe a previously unreported case of warfarin-induced spontaneous elbow hemarthrosis, diagnosed by point-of-care ultrasound. On the basis of clinical and ultrasound findings arthrocentesis was deferred, and the patient was successfully treated with warfarin reversal and conservative care. Physical examination is unreliable for the detection of a joint effusion, and misdiagnosis and can lead to unnecessary investigation or resource use. Point-of-care ultrasound allows accurate, prompt, direct visualization of a joint effusion, and non-invasive confirmation of a hemarthrosis. Ultrasound can facilitate accurate diagnosis and characterization of joint effusions to improve the care of patients with coagulopathy.

Keywords: Hemarthrosis; Joints; Ultrasonography; Warfarin.

Fig. 1.

Longitudinal view of the left elbow demonstrating a heterogeneous, hyperechoic effusion (arrow).

Fig. 2.

Posterior transverse view of the elbow with hemarthrosis (triangle).

Fig. 3.

Lateral X-ray of the elbow demonstrating soft tissue swelling and effusion without evidence of fracture.