A Blast from the Past: Lower Extremity Spontaneous Hematoma Rupture

Friday, October 24, 2025

8:00 AM - 9:15 AM MT

Location: Kiosk 2

Primary Author(s)

Adam T. Schulman, MD (he/him/his)

Resident Physician
Icahn School of Medicine At Mount Sinai PM&R Program
Piscataway, New Jersey

Co-Author(s)

Katharine Holmes, Other

Medical Studen
Icahn School of Medicine
New York, New York
Eric Jones, MD

Resident Physician
Icahn School of Medicine At Mount Sinai PM&R Program
New York, New York
CT

Carley Trentman, MD

Assistant Professor
Icahn School of Medicine At Mount Sinai PM&R Program
New York, New York
EH

Emily Hon, MD

Attending
Glen Cove Hospital, Northwell Health
Mineola, New York

Disclosure(s):

Adam T. Schulman, MD: No financial relationships to disclose

Katharine Holmes, Other: No financial relationships to disclose

Emily Hon, MD: No financial relationships to disclose

Case Diagnosis: Right lower extremity hematoma spontaneous rupture

Case Description or Program Description: A 90-year-old female with a medical history of strokes, atrial fibrillation on eliquis, hypertension, hyperlipidemia, and diabetes presented to her inpatient rehab team with right knee pain that radiated to the calf, without any history of trauma. Within hours, a large fluctuant mass developed over the right superior medial calf, which was exquisitely tender to light palpation. The mass quickly expanded past ink boundaries established the day prior.

Setting: Inpatient Rehabilitation Facility

Assessment/Results: While being evaluated by vascular surgery, the mass spontaneously ruptured, revealing blood and clotted contents. The patient became hypotensive and tachycardic but reported pain relief. The vascular team drained the wound, applied a firm ACE bandage from the knee to the toes. Anticoagulation/antiplatelet medications were held. CTA abdomen and pelvis showed a large hematoma of the right medial calf with numerous foci of active bleeding. The patient was transferred to a medicine service and managed conservatively with ACE wrapping, three transfusions, and antibiotic prophylaxis given the size and depth of the wound. Once the patient stabilized, she was transferred back to inpatient rehab and finished her hospital course with no further complications.

Discussion (relevance): This case highlights the rare but life threatening case of a spontaneous hematoma rupture in an anticoagulated patient on an inpatient rehabilitation unit. The rapid expansion of fluctuance, subsequent rupture, and hemodynamic instability of the patient emphasize the need for early recognition and intervention as guided by physical exam and adjunctive radiography.

Conclusions: Spontaneous hematomas are a rare but life threatening event on the rehabilitation floor that require prompt recognition and treatment. Thorough physical exam, proper radiography, and expedited treatment ensure optimal outcomes.