Spontaneous massive abdominal wall hematoma in polycythemia vera

Area of Science:

• Internal Medicine
• Hematology
• Diagnostic Imaging

Background:

• Polycythemia vera (PV) is a myeloproliferative neoplasm characterized by increased red blood cell mass.
• Patients with PV often have elevated platelet counts, increasing the risk of bleeding or thrombosis.
• Acute abdominal presentations in PV patients are uncommon but can be severe.

Observation:

• An 87-year-old male with known polycythemia vera presented with an acute abdomen.
• Abdominal ultrasonography revealed a large (22 x 15 x 8 cm) homogeneous echogenic mass anterior to the peritoneum, consistent with a hematoma.
• The patient's platelet count was significantly elevated at 937,000/mm3.

Findings:

• The abdominal mass was diagnosed as a spontaneous abdominal wall hematoma.
• The patient's condition improved with plateletpheresis and supportive care, indicating a hematoma related to his polycythemia vera.
• The diagnosis was aided by ultrasonography, preventing surgical intervention.

Implications:

• This case highlights that older patients with polycythemia vera may present with acute abdomen secondary to spontaneous abdominal wall hematomas.
• Diagnostic imaging modalities such as computerized tomography (CT) or ultrasonography are vital for accurate diagnosis.
• Utilizing imaging can prevent unnecessary surgical exploration in patients with polycythemia vera presenting with acute abdominal symptoms.