The syndrome of the "coup de fouet". Is it always a benign disease?

BACKGROUND. The coup de fouet syndrome is an uncommon condition characterized by a spontaneous intramuscular venous hemorrhage of the calf, sometimes accompanied by a deep thrombosis of the leg. OBJECTIVE. The purpose of this work is to verify the real incidence of the thrombotic complications, making use of the most recent noninvasive diagnostic instruments, such as the duplex scanner and color Doppler. METHODS. From January 1992 to December 1993, we examined 24 subjects (average age, 38.5 years) suffering from the so-called coup de fouet syndrome, which had appeared during physical activity : walking (nine cases), running (six cases), and sudden changes of position (nine cases). In all cases we performed a clinical and instrumental examination (analogical and tensive arterial and venous Doppler, arterial and venous duplex scanner, and color Doppler). RESULTS. Clinically we found, in 17 subjects, a hematoma in the posterior calf with increased thickness and, in 10 cases, with spontaneous sharp pain. In the other seven cases we found a modest hematoma without subjective or other objective symptoms. The arterial Doppler and scanner findings were normal. In the first group of 17 cases, the average clinostatic Doppler venous pressure, measured using a method developed by us and already described, was 32 ± 4 mm Hg (normal value, 15 ± 7 mm Hg) ; in the other seven cases the value was 19 ± 4 mm Hg. CONCLUSION. The duplex scanner and color Doppler examination confirmed in all subjects the presence of an intrafascial hematoma in the gemellar zone ; in 10 cases (41.7%), with more painful symptomatology, in a zone contiguous to the hemorrhage, we found a gemellar (six cases) or popliteal (four cases) phlebothrombosis. Lastly, we must point out that the syndrome is not always benign and that, therefore, a correct and more vigilant diagnostic and therapeutic approach is necessary.