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Case Reports
. 2024 Nov 22;20(2):909-915.
doi: 10.1016/j.radcr.2024.10.109. eCollection 2025 Feb.

Polycythemia vera with acute coronary syndrome and bleeding as initial presentation: A case report and literature review

Rabia Iqbal  1 , Aemen Shafqat Bazaz  2 , Ahmad Taimoor Bajwa  1 , Hnin Nadi Linn  1 , Nyan Linn Htet  1 , Sabrin Marowa  3 , Asmat Ullah  4
Affiliations
Case Reports

Polycythemia vera with acute coronary syndrome and bleeding as initial presentation: A case report and literature review

Rabia Iqbal et al. Radiol Case Rep. .

Abstract

Polycythemia vera (PV) is a chronic myeloproliferative disorder characterized by increased red blood cell mass, leading to a heightened risk for thrombosis and hemorrhage. While thrombotic complications such as stroke, deep vein thrombosis, and pulmonary embolism are commonly associated with PV, coronary artery syndromes, as the initial presentation, are rare. Here, we present the case of a 73-year-old male who presented with severe chest pain and was diagnosed with non-ST-elevation myocardial infarction (NSTEMI). During his hospitalization, the patient experienced spontaneous psoas muscle hemorrhage, which prompted further investigation. Laboratory workup revealed elevated hemoglobin levels and a positive JAK2 V617F mutation, confirming a diagnosis of polycythemia vera. This case highlights the importance of considering myeloproliferative disorders in patients with atypical thrombotic and hemorrhagic events. It emphasizes the need for early diagnosis and appropriate treatment to optimize patient outcomes.

Keywords: Acute coronary syndrome; Myeloproliferative disorders; Polycythemia vera; Thromboembolic events.

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Figures

Fig 1:
Fig. 1
Initial electrocardiogram showing normal sinus rhythm with left atrial enlargement.
Fig 2:
Fig. 2
CT scan of abdomen and pelvis showing marked swelling of the left psoas and left iliacus with mass-effect on the adjacent bowel with heterogeneous density indicative of hemorrhage.
Fig 3:
Fig. 3
CT angiogram of the abdomen and pelvis shows Active extravasation of IV contrast into the swollen hemorrhagic left psoas muscle indicative of active bleeding.
Fig 4:
Fig. 4
(A) (B): Arteriography of the abdominal aorta and iliac arteries without evidence of contrast extravasation to denote an active bleed.
Fig 5:
Fig. 5
Graph showing the trend of hemoglobin during the hospital stay.
Fig 6:
Fig. 6
Ultrasound of the abdomen showing enlarged spleen measuring 21 × 12.5 × 8.6 cm which corresponds to volume of 1196 cc.
See this image and copyright information in PMC

References

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