Leg Swelling Caused by Heterotopic Ossification Mimicking Deep Vein Thrombosis in a Paraplegic Patient

Korean J Neurotrauma, 2015 · DOI: http://dx.doi.org/10.13004/kjnt.2015.11.2.158 · Published: August 22, 2015

Spinal Cord Injury Cardiovascular Science Musculoskeletal Medicine

Simple Explanation

Leg swelling in paraplegic patients can arise from various causes such as heterotopic ossification (HO), deep vein thrombosis (DVT), fractures, or cellulitis. Differentiating between these conditions can be challenging because their clinical presentations may overlap. DVT is particularly concerning due to the risk of pulmonary embolism. Therefore, prompt and accurate diagnosis is critical. This case report discusses a paraplegic patient with leg swelling caused by HO mimicking DVT, highlighting the importance of considering HO in the differential diagnosis of leg swelling in such patients.

Study Duration

Not specified

Participants

A 35-year-old man with C7 tetraplegia

Evidence Level

Case Report

Key Findings

1
The patient's leg swelling was initially suspected to be DVT due to the diffuse nature of the swelling throughout the entire leg.
2
Computed tomography venography revealed HO anteromedial to the left femur, compressing the external iliac vein, and no evidence of DVT.
3
Treatment with etidronate and radiation therapy led to improvement in leg swelling at the 3-month follow-up, though radiographic regression of HO was not confirmed.

Research Summary

Leg swelling in paraplegic patients can be caused by heterotopic ossification (HO), deep vein thrombosis (DVT), fracture, or cellulitis, and these conditions can be difficult to distinguish clinically. DVT is a significant cause of morbidity and mortality in patients with SCI, so a prompt diagnostic work-up is essential to identify the cause of leg swelling. CTV can be a useful imaging modality to rule out DVT, HO, fracture, and cellulitis at one time, especially when DVT is not evident on USG.

Practical Implications

Differential Diagnosis

HO should be considered in the differential diagnosis of leg swelling in paraplegic patients, especially when clinical signs mimic DVT.

Diagnostic Imaging

CTV can be a useful imaging modality to evaluate leg swelling and to differentiate between DVT, HO, fracture, and cellulitis.

Prompt Evaluation

A prompt diagnostic work-up is essential to identify the cause of leg swelling, particularly for DVT, to avoid mortality and morbidity.

Study Limitations

1
This is a case report, so the findings cannot be generalized to all paraplegic patients.
2
Radiographic regression of HO was not confirmed after treatment.
3
The study does not discuss long-term outcomes.

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