The Hemorrhage that Wasn’t: Polycythemia Presenting as a Pseudointracranial Hemorrhage in Pedestrian vs Automobile Trauma Alert

Abstract

Introduction: Although polycythemia vera is rarely seen, absolute polycythemia is seen more frequently and can drastically change imagine interpretation when taken out of context of the patient’s chief complaint. Case Report: We report the case of a 21-year-old male without any known medical history who presented as a trauma patient initially diagnosed with acute subarachnoid and subdural hemorrhages. Further examination of the imaging and later serum laboratory findings demonstrated a primary diagnosis of absolute polycythemia, which was an incidental diagnosis that resulted in the patient’s care team and disposition being changed.Conclusion: Absolute polycythemia is not uncommon, and its causes vary from congenital and myeloproliferative disorders to chronic obstructive pulmonary disease and sleep apnea. It can cause pseudoenhancement in noncontrast computed tomography (CT) scans because of the increased protein level in the blood, and emergency physicians should consider all differential diagnoses of pseudoenhancement

Keywords

• Polycythemia, trauma, erythrocytosis, false positive interpretation

References

1. Keohane C, McMullin MF, Harrison C. The diagnosis and management of erythrocytosis. BMJ. British Medical Journal Publishing Group; 2013; 18: 347(nov18 1): f6667–7.
2. Keohane C, McMullin MF, Harrison C. The diagnosis and management of erythrocytosis. BMJ 2013; 18: 347. [CrossRef]
3. Parizel PM, Makkat S, Van Miert E, Van Goethem JW, van den Hauwe L, De Schepper AM. Intracranial hemorrhage: principles of CT and MRI interpretation. Eur Radiol 2001; 11: 1770–83. [CrossRef]
4. Kulkarni AG, Kharche J, Sheth K, Dube V. Polycythaemia Vera presenting as Cerebral Venous Sinus Thrombosis–A Case Report. Platelets
5. Javedan SP, Marciano F. Pseudo-enhancement from polycythemia. Neurology 2004; 62: 150. [CrossRef]
6. Lim BK. Clinics in diagnostic imaging (146). Polycythaemia vera (PV). Singapore Med J. 2013 May;54(5):289–91–quiz292.
7. Lin C-Y, Lai P-H, Fu J-H, Wang P-C, Pan H-B. Pseudo-subarachnoid hem- orrhage: a potential imaging pitfall. Can Assoc Radiol J 2014; 65: 225– 31. [CrossRef]