Abstract Number: PB0710
Meeting: ISTH 2021 Congress
Background: Musculoskeletal ultrasound (MSK-US) in patients with congenital bleeding disorders is a valid tool for the differential diagnosis of acute joint pain. MSK-US can also help identifying less frequent periarticular complications of bleeding disorders.
Aims: Hemorrhagic adventitious bursitis of a subcutaneous bursa over the II-III metatarsal heads was found in a 57-year-old patient with type 3 Von Willebrand disease (VWD) -basal FVIII plasma 1%, VWF:Ag <3% and VWF:RCo <6% – and arthropathy of the ankles and left elbow, requiring prophylaxis with FVIII/VWF (Haemate-P) 2000 UI twice weekly. Furthermore, she is affected by systemic lupus erythematosus for which she is treated chronically with a low daily dose of prednisone. She has normal BMI (19.5).
Methods: The patient referred to the Angelo Bianchi Bonomi Hemophilia and Thrombosis Center for pain in the forefoot after walking and jogging in the mountains. The MSK-US examination was performed with a Philips Affinity 50 ultrasound machine with a 5-12 MHz linear probe.
Results: The physical examination showed swelling and pain of the forefoot compatible with collapse of the distal transverse foot arch (DTFA) (Figure 1) confirmed with MSK-US examination of the dorsal and plantar forefoot. Figure 2 shows a longitudinal scan (A) and a transverse scan (B) of a subcutaneous hemorrhagic bursitis over the II and III metatarsophalangeal joints of the left foot. The patient was treated with Haemate-P 2000 UI every other day for a week with benefit.
Conclusions: Serous bursae are normally present at the plantar side of the I and V metatarsal bones (also known as Lenoir’s bursae) in subjects with a normal DTFA. The subcutaneous bursa we described can be considered as the equivalent of these bursae formed as a consequence of collapse of the DTFA for repeated trauma eventually leading to bleeding and inflammation (hemorrhagic bursitis).
To cite this abstract in AMA style:Gualtierotti R, Stella SM, Biguzzi E, Siboni SM, Arcudi S, Solimeno LP, Payvandi F. Hemorrhagic Adventitious Bursitis of the Foot in a Patient with Congenital Type 3 von Willebrand Disease [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/hemorrhagic-adventitious-bursitis-of-the-foot-in-a-patient-with-congenital-type-3-von-willebrand-disease/. Accessed November 29, 2021.
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