A Case of Therapeutic Embolization of Hemarthrosis due to Pseudoaneurysm / 대한류마티스학회지

ABSTRACT

Hemarthrosis can occur in patients with a predisposition to hemorrhage such as hemophilia or anticoagulant therapy. A 72-year-old man presented with an acute painful swelling in the right knee. He was on anticoagulant therapy after a mechanical aortic valve replacement due to aortic valve insufficiency. There was no history of trauma and international normalized ratio (INR) was maintained at 3.76. On arthrocentesis of the knee, bloody synovial fluid was obtained. With the diagnosis of hemarthrosis, INR was maintained at 2. With immobilization, the knee pain gradually improved. Three weeks after discharge, right knee painful swelling was exacerbated, and arthrocentesis again revealed bloody synovial fluid. After magnetic resonance imaging (MRI) was performed, pseudoaneurysm of the right lateral superior genicular artery was diagnosed. The angiographic embolization was performed after which, he showed marked improvement. Knee MRI should be considered in hemarthrosis with atypical clinical progress, because it can detect lesions amenable to therapeutic intervention as in this case.