Hemophilic pseudotumors: Natural history and a case report of pseudotumor with femur fracture and swan-neck deformity

Introduction: A haemophilic pseudotumor is an encapsulated, chronic, slowly expanding hematoma, usually involving the musculoskeletal system. Pseudotumors cause pressure erosion of adjacent bone and other pressure effects. We present a case report of neglected pseudotumors and everything that can go wrong, complicating management so much that we were left with amputation as the only option. We present review of literature and natural history of hemophilic pseudotumors, which will explore all the relevant data on the clinical presentation, diagnosis and especially management of this condition. We also present association of haemophilia with dynamic swan neck deformity of both hands, which is first of its kind report. Case presentation: We present case report of a 70 year old Male patient with two massive pseudotumor and a femur fractures. The patients case was complicated by presence of severe joint contractures, hepatitis C and other problems. Conclusion: Hemophilia is a devastating disease; it is even more devastating if a poor man has it. No rule of thumb and no standard treatment protocol exists for management of pseudotumors. Therapy for haemophilic pseudotumor should be selected on a case-by-case basis along with the full involvement of a hemotologist. In severe and neglected cases like ours, often amputation remains the only option, and in developing countries sometimes even this option is not available to the patient.