Spontaneous chest wall hematoma- an uncommon presentation of chronic myeloid leukemia

Introduction & Background: Spontaneous hematomas are most commonly caused by bleeding and clotting disorders followed by anticoagulant and antiplatelet drugs. Spontaneous hematoma secondary to malignancy is usually uncommon. CML is the hematological malignancy known for variability in presentation. Spontaneous hematomas are unusual presentation of CML with only few cases reported. Case History: A 63 years old male, presented with complaint of sudden painful, boggy swelling over the left chest wall few hours following trivial trauma. No history of drug intake, joint swelling following trauma or similar episodes in past. No history of similar illness in family members. On examination he was pale, the vital signs were within normal limits. The swelling was warm, firm, tender and overlying skin was reddish. He had a huge, firm, non-tender splenomegaly. He had no petechiae, purpura, ecchymosis or other swelling over his body. Other system examinations were within normal limits. Investigations: Hemoglobin7.6 g%, TLC474,300/mm 3 with immature Neutrophil precursors, suggestive of CML. Liver and renal function tests were normal. PT/INR and APTT were not significantly raised. Serum LDH was 859 and serum Uric Acid was 7. Chest X-ray showed homogenous opacity in left lung field. USG of chest wall was suggestive of intramuscular hematoma extending upto lower scapular region. USG abdomen revealed gross splenomegaly (22 cm). Bone marrow examination was suggestive of CML in chronic phase. Karyotyping revealed Ph’ chromosome in 100 % cells. Chromosomal study showed BCR-ABL gene positive CML (ISNCN52.45 %). Management: Chest wall hematoma resolved spontaneously with conservative management within 3 weeks. Patient was started on Hydroxyurea for cytoreduction and later on Imatinib was started. Conclusion & Discussion: Few cases of spontaneous hematoma with CML have been reported till now. However, the exact mechanism of spontaneous hematoma in CML is not known. Further research is required to understand the exact mechanism and its management.