Giant spontaneous hematoma of the thoracic wall in a patient with REST syndrome

We report on a 56-year-old patient with systemic sclerosis of one and a half year's duration who was admitted with an acute soft tissue swelling over the left scapula and a marked reduction of joint mobility of the left shoulder. Over the following days, the swelling extended distally and a hemorrhagic discoloration developed, reaching down to the scrotum. Nuclear magnetic resonance imaging revealed a giant intermuscular hematoma between the serratus anterior and the costal muscles. This is the first report of an extensive spontaneous hematoma of the thoracic wall in a patient with progressive systemic sclerosis. Its development and unusual localization may be explained by both the underlying systemic sclerosis and the patient's previous profession as a trapeze artist. Hemorrhagic complications of systemic sclerosis are rare but should be watched for in these patients.