E-ISSN 2149-9934
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The Hemorrhage that Wasn’t: Polycythemia Presenting as a Pseudointracranial Hemorrhage in Pedestrian vs Automobile Trauma Alert
1 Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA  
2 Department of Internal Medicine, Division of Hematology and Oncology, Stanford University, Stanford, USA  
3 Department of Radiology, Stanford University, Stanford, USA  
4 Department of General Surgery, Stanford University, Stanford, USA  
5 Department of Radiology, Division of Neuroimaging, Stanford University, Stanford, USA  
JEMCR 2018; 9: 26-29
DOI: 10.5152/jemcr.2018.2003
Key Words: Polycythemia, trauma, erythrocytosis, false positive interpretation
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.

 

Cite this article as: Philips AW, Baird JH, Wentland AL, Yang RL, Massoud TF. The Hemorrhage that Wasn’t: Polycythemia Presenting as a Pseudointracranial Hemorrhage in Pedestrian vs Automobile Trauma Alert. J Emerg Med Case Rep 2018; 9: 26-29.

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