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Biceps pain

 

History: A 74-year-old female with a history of atrial fibrillation presents to the ED with 3 hours of right biceps pain.  There was no history of fever, heavy lifting or injury.  She does not know what medications she takes.

Exam: Vital signs were normal.  Physical exam was normal except for swelling, firmness, tenderness and slight ecchymosis to the right biceps area with no other findings concerning for compartment syndrome.  She had good range of motions, sensation and pulses.

Initial Concern(s): Spontaneous bleed, compartment syndrome, biceps tendon rupture, infection thought less likely

Testing: See CT of the biceps below (requested by admitting MD).

eliquis-biceps-bleed

Question(s): What does the IMAGE show?  What should you do next?

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ANSWER: The patient was on Eliquis.  The CT showed a hematoma within the biceps with a small area of active extravasation (white).  

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noacs

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CASE CONCLUSION: The patient’s swelling and pain worsened so she was given FFP and cryoprecipitate.  She did not require surgery and was doing better the next day.

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