Spontaneous scapular region hematoma extending upto anterior chest wall in a patient of chronic myeloid leukaemia: an unusual site presentation

Vaibhav Raj Gopal, Akash Srivastava, Neha Yadav, Vineet Kumar Singh


Spontaneous haemorrhage and thrombosis should always raise the suspicion of CML as one of the differential as it is associated with qualitative platelet dysfunction. We here report a rare case of CML with spontaneous hematoma at an unusual site. A 26 years male presented with complaints of sudden onset non traumatic spontaneous swelling over the left scapular region and progressively extending up-to the left anterior chest wall which was associated with dull aching moderate intensity pain. Swelling was warm, soft in consistency and tender. He also had hepato-splenomegaly. General blood picture showed marked leucocytosis with myeloid hyperplasia. CT scan thorax reported a large hypodense lesion in the scapular and anterior chest wall region which on diagnostic aspiration revealed blood thereby confirming the diagnosis of spontaneous hematoma with CML. Imatinib therapy was started and hematoma was managed conservatively with antibiotics. The swelling resolved spontaneously without any surgical intervention.  


Chronic myeloid leukaemia, Philadelphia chromosome, Hematoma, Platelet dysfunction, Imatinib, Chest wall swelling

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Howlader N, Noone A, Krapcho M, Neyman N, Aminou R, Altekruse S et al (Editors). SEER Cancer Statistics Review. 2009;1975-2009. Available at: Accessed 10 March 2012.

Wehmeier A, Schneider W. Megakaryocytes and platelets as the main cause for vascular events in chronic myeloproliferative disorders. Hamostaseologie. 1996;16:151-63.

Prasad BC, Chandra VV, Varaprasad G. Dural metastases in chronic myeloid leukemia presenting as subdural hematoma. Turk Neurosurg. 2012;22(6):777-8.

Jain A, Prasad P, Chaudhry S, Gupta DK, Saluja S. Spontaneous Acute Subdural Hematoma as an Initial Presentation of Chronic Myeloid Leukemia. Indian J Hematol Blood Transfus. 2019;35(3):578-79.

Peter G, Shishir N, Narasimha H. Spontaneous chest wall hematomaUnusual presentation of chronic myeloid leukaemia. J Med. 2012;13:94-6.

Yasir B. Unusual presentation of chronic myeloid leukaemia as retroperitoneal hematoma: a case report. Am J Med Case Rep. 2014;2:227-8.

Dwebi M, Cumber P. Spontaneous chest wall haematoma in chronic myeloid leukaemia. The Egyptian Journal of Internal Medicine. 2019;31:385-7.

Kartthik S, Mandal PK, Abdullah SM. An Unusual Cause of Bleeding in a Patient with Chronic Myeloid Leukemia Chronic Phase. Case Rep Hematol. 2019;2019:5674193.

Schafer AI. Bleeding and thrombosis in the myeloproliferative disorders. Blood. 1984;64:1-12.

Moore SF, Hunter RW, Harper MT. Dysfunction of the PI3 kinase/Rap1/integrin IIb 3 pathway underlies ex vivo platelet hypoactivity in essential thrombocythemia. Blood. 2013;121(7):1209-19.

Chauhan R, Sazawal S, Singh K. Reversal of Glanzmann thrombasthenia platelet phenotype after imatinib treatment in a pediatric chronic myeloid leukemia patient. Platelets. 2018;29(2):203-6.

Jain A. A rare case of chronic myeloid leukemia with acquired von Willebrand disease presenting as subdural hematoma. J Can Res Ther. 2015;11:1022.

Turrito VT, Weiss HJ. Red blood cells: their dual role in thrombus formation. Science. 1980;207:57-78.

Hyams ES, Gupta R, Melamed J, Taneja S, Shah O. Renal involvement by chronic myelomonocytic leukaemia requiring nephroureterectomy. Rev Urol. 2009;11:33-7.

Shimabukuro-Vornhagen A, Rothe A, Nogova L, Kochanek M, Scheid C, von Bergwelt-Baildon M. Improvement of platelet dysfunction in chronic myelogenous leukemia following treatment with imatinib: a case report. J Med Case Rep. 2011;5:215.

Quinta´s-Cardama A, Han X, Kantarjian H, Cortes J. Tyrosine kinase inhibitor-induced platelet dysfunction in patients with chronic myeloid leukemia. Blood. 2009;114(2):261-3.

Yurttas NO, Eskazan AE. Tyrosine Kinase Inhibitor–Associated Platelet Dysfunction: Does This Need to Have a Significant Clinical Impact? Clinical and Applied Thrombosis/Hemostasis. 2000;25:1-3.

Akay OM, Mutlu F, Gülbaş Z. Platelet Dysfunction in Patients with Chronic Myeloid Leukemia: Does Imatinib Mesylate Improve It? Turkish Journal of Haematology: Official Journal of Turkish Society of Haematology. 2016;33(2):127-30.

Sener Y, Okay M, Aydin S, Buyukasik Y, Akbiyik F, Dikmen ZG. TKI-related platelet dysfunction does not correlate with bleeding in patients with chronic phase-chronic myeloid leukemia with complete hematological response. Clin Appl Thromb Hemost. 2019;25.