Abdominal Subcutaneous Hematoma.

A 79-year-old woman with osteoporosis and polycythemia vera (PV) treated with aspirin and hydroxycarbamide developed right-sided abdominal pain immediately after a self-administered subcutaneous teriparatide injection (Picture 1, yellow arrow). On physical examination, her body mass index was 18.9 kg/m2, and we observed abdominal swelling with subcutaneous bleeding (Picture 1). Laboratory tests revealed the platelet count to be elevated at 62.9×104/μL and coagulation screening was normal (prothrombin time 12.2 seconds and activated partial thromboplastin time 31.5 seconds). Computed tomography revealed a right abdominal subcutaneous hematoma measuring 69.5×51.4 mm in size (Picture 2A, B). The distance between the skin surface and the superficial epigastric artery (SEA) (Picture 2C, arrow) was 6.5 mm. The patient used a 29 gauge needle, measuring 6.0 mm in length, and injection-induced subcutaneous fat compression might lead to an SEA puncture with acute abdominal pulsating pain because SEA was not detected at the hematoma. The hematoma could not be aspirated using a syringe (Picture 1, black arrow), but resolved 2 months later. Thin patients should therefore be advised to avoid injecting too deeply or should inject themselves through clothing (1). Our findings suggest that subcutaneous injection should be chosen carefully when treating thin patients due to an increased risk of hemorrhaging. PV may cause massive subcutaneous hemorrhaging (2); therefore, the treatment of this patient was switched from teriparatide injections to oral risedronate therapy.

Picture 1.

Picture 2.

The authors state that they have no Conflict of Interest (COI).