Acute pediatric leg compartment syndrome in chronic myeloid leukemia.

Full article available online at Healio.com/Orthopedics Figure: Preoperative magnetic resonance imaging axial proton density fat-saturated image of the left leg showing a heterogeneous mass in the medial and lateral gastrocnemius muscle. Fluid signal is seen centrally within the mass, with surrounding edema. Acute Pediatric Leg Compartment Syndrome in Chronic Myeloid Leukemia Eric cohEn, MD; JErEMy TrunTzEr, MD; STEvE KlingE, MD; KEvin SchwarTz, MD; JonaThan SchillEr, MD Acute compartment syndrome is an orthopedic surgical emergency and may result in devastating complications in the setting of delayed or missed diagnosis. Compartment syndrome has a variety of causes, including posttraumatic or postoperative swelling, external compression, burns, bleeding disorders, and ischemia-reperfusion injury. Rare cases of pediatric acute compartment syndrome in the setting of acute myeloid leukemia and, even less commonly, chronic myeloid leukemia have been reported. The authors report the first known case of pediatric acute compartment syndrome in a patient without a previously known diagnosis of chronic myeloid leukemia. On initial examination, an 11-year-old boy presented with a 2-week history of progressive left calf pain and swelling after playing soccer. Magnetic resonance imaging scan showed a hematoma in the left superficial posterior compartment. The patient had unrelenting pain, intermittent lateral foot parethesias, and inability to bear weight. Subsequently, he was diagnosed with acute compartment syndrome and underwent fasciotomy and evacuation of a hematoma. Laboratory results showed an abnormal white blood cell count of 440×109/L (normal, 4.4-11×109) and international normalized ratio of 1.3 (normal, 0.8-1.2). Further testing included the BCR-ABL1 fusion gene located on the Philadelphia chromosome, leading to a diagnosis of chronic myeloid leukemia. Monotherapy with imatinib mesylate (Gleevec) was initiated. This report adds another unique case to the growing literature on compartment syndrome in the pediatric population and reinforces the need to consider compartment syndrome, even in unlikely clinical scenarios. The authors are from the Department of Orthopaedics (EC, JT, SK, JS), Brown University, Providence; and the Department of Pediatric Hematology/Oncology (KS), Warren Alpert Medical School, Brown University, Rhode Island Hospital, Providence, Rhode Island. The authors have no relevant financial relationships to disclose. Correspondence should be addressed to: Eric Cohen, MD, Department of Orthopaedics, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (eric_cohen@brown.edu). Received: December 20, 2013; Accepted: March 25, 2014; Posted: November 6, 2014. doi: 10.3928/01477447-20141023-91 This article has been amended to include a factual correction. An error was identified subsequent to its original publication. This error was acknowledged on page 7, volume 38, issue 1. The online article and its erratum are considered the version of record.