Case report of unique presentation of spontaneous calf hematoma

The presentation of spontaneous hematomas remains different between all affected populations, but advanced age and use of anticoagulants are common risk factors in the majority. The progression of the hematoma may require some time to be detected; however, it can prove fatal if it reaches a significant size. A spontaneous calf hematoma can be mistakenly diagnosed as deep vein thrombosis, and the management of both conditions is varying. A 26-year-old man had recently undergone multiple left lower limb surgeries and was using Rivaroxaban for deep vein thrombosis prophylaxis. He presented with a painful contralateral calf swelling for a duration of one month, which was later diagnosed as a spontaneous chronic calf hematoma. Despite the fact that blood tests were within the normal range, imaging confirmed the diagnosis. After extensive discussion among multidisciplinary teams, a surgical exploration was conducted, resulting in the complete evacuation of the hematoma. Subsequently, a meticulous monitoring of the re-administration of anticoagulant was conducted. spontaneous calf hematoma is not common pathology and affecting elderly and presentation in young is unique and diagnosis will not be reached easily especially in chronic case. A spontaneous calf hematoma can occur in a young, fit population with coexisting anticoagulant administrations. A thorough history, examination, and imaging must be applied urgently in order to reach a diagnosis. •Spontaneous hematoma has different presentation form and must be carefully diagnosed and managed accordingly.•Spontaneous hematoma of lower limb may mimic pathologies such as: deep vein thrombosis, cellulitis, traumatic hematoma and sarcoma.•Doppler ultrasound alongside with computerized tomography useful tools to diagnose spontaneous leg hematoma.