Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3835-3840
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3835
Diagnosis of an actively bleeding brachial artery hematoma by contrast-enhanced ultrasound: A case report
Jiao-Jiao Ma, Bo Zhang
Jiao-Jiao Ma, Bo Zhang, Department of Ultrasound, China-Japan Friendship Hospital, Beijing 100029, China
Author contributions: Zhang B performed the contrast-enhanced ultrasound examination and contributed to manuscript drafting; Ma JJ reviewed the literature and contributed to manuscript drafting; Zhang B and Ma JJ analyzed and interpreted the imaging findings; Zhang B and Ma JJ were responsible for the revision of the manuscript for important intellectual content; all authors issued final approval for the version to be submitted.
Supported by the Peking Union Medical College and Chinese Academy of Medical Sciences, No. 201920102305.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bo Zhang, MD, Chief Physician,Department of Medical Ultrasonics, China-Japan Friendship Hospital, No. 2 Yinghua East Road, Beijing 100029, China. zora19702006@163.com
Received: May 2, 2020
Peer-review started: May 2, 2020
First decision: May 21, 2020
Revised: July 16, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: September 6, 2020
Processing time: 124 Days and 19.4 Hours
Abstract
BACKGROUND

Active bleeding due to arterial injury following the acupuncture can sometimes represent a life-threatening complication. Only few reports of an actively bleeding hematoma diagnosed by contrast-enhanced ultrasound, which enables the depiction of vascular, have been reported.

CASE SUMMARY

Here, we report the case of a 75-year-old woman, who presented with sudden swelling, ecchymosis, and pain in the upper left limb. She underwent an acupuncture treatment of traditional Chinese medicine followed by a deep shoulder massage 2 d before admission to hospital. A few hours after the massage, her left upper arm was red, swollen and progressively aggravated. Ultrasonography showed a large hematoma (11.2 cm × 3.5 cm × 3.4 cm) beside the left brachial artery. Color Doppler ultrasound revealed that blood flow signals of the arteries branched into the hematoma. The contrast-enhanced ultrasound showed microbubbles from the brachial artery passing into the hematoma, diffused within the hematoma with the local surge of red blood cells, and disappearing after approximately 17 s. The microbubbles were likely due to bleeding from the arteries. After pressure bandaging treatment, the hematoma became smaller (3.1 cm × 1.7 cm) and organized according to ultrasonography performed 20 d later.

CONCLUSION

This case highlights the ultimate importance of contrast-enhanced ultrasound for the diagnosis of an actively bleeding hematoma.

Keywords: Acupuncture; Ultrasonography; Bleeding; Contusion; Case report

Core tip: Active bleeding due to arterial injury following acupuncture can sometimes represent a life-threatening complication. We present herein, a rare case of actively bleeding brachial artery hematoma diagnosed by contrast-enhanced ultrasound (CEUS). CEUS enables the depiction of microvascularization, and has the potential to replace computed tomography in assessments for active bleeding. This case highlights the ultimate importance of CEUS for the diagnosis of an actively bleeding hematoma.