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Warfarin-induced spondyloarthropathy with pseudotumor-like appearance. A case report
E E Awwad1, R J Bernardi, M Sundaram
1Department of Radiology, St. Louis University Health Sciences Center, Missouri, USA.
Study Design:
This case report illustrates an unusual complication of chronic warfarin administration.
Objectives:
The presurgical determination that the destructive process at L1-L2 was not infection or neoplasm involved the recognition that there was instability at this level resulting from chronic stress fractures.
Summary Of Background Data:
Periosteal or osseous hemorrhagic masses (pseudotumors) have been well described in patients with hemophilia. To the authors' knowledge, this is the first reported case of this well-known phenomenon occurring in the axial skeleton as a consequence of warfarin administration.
Methods:
Serial radiographic studies of the lumbar spine were available showing a progressive destructive lesion at L1-L2 and coinciding with the initiation of warfarin anticoagulation after aortic valve replacement.
Results:
The destructive mass was demonstrated surgically to represent a large partially solidified chronic hematoma.
Conclusions:
Patients with stress fractures of the posterior arch and subsequent instability may be subject to development of such a spondyloarthropathy. Recognition of this unusual potential complication of warfarin therapy would prevent an incorrect diagnosis of tumor or infection. Early recognition of its occurrence could lead to early spinal stabilization.