Intramuscular hematoma of the vastus lateralis following percutaneous skeletal muscle micro-biopsy: a case report

Abstract Background. Recently, percutaneous micro-biopsy needles have been used as a less invasive alternative to the Bergstrom needle for obtaining human skeletal muscle biopsy. Unlike the Bergstrom muscle biopsy procedure, potential complications associated with micro-biopsies of human skeletal muscle have not been documented. Therefore, the present case report follows a young male’s recovery from a muscle biopsy induced hemorrhage/hematoma of the right vastus lateralis with the specific aims of 1) informing future participants, researchers and clinicians on expected time course of recovery and 2) informing methods to minimize future participant adverse event risk during and after the percutaneous micro-biopsy procedure.Case Presentation. A 23-year-old male had a muscle biopsy completed on the right vastus lateralis. One day following the micro-biopsy procedure, the participant experienced severe sharp, shooting and throbbing pain. Rest, ice, compression and elevation was immediately advised. Five days later, the participant re-experienced severe sharp, shooting and throbbing pain. The participant could not walk and was driven to have an ultrasound completed of the anterolateral aspect of the right thigh. The ultrasound revealed a pulsatile mass in the deeper aspect of the right vastus lateralis, below the site of incision. We interpreted the ultrasonography images to suggest that the participant suffered from a muscle biopsy-induced hemorrhage of an artery in the right vastus lateralis leading to an intramuscular hematoma. Pain remained elevated until day 8 when pulsatile flow ceased. Thereafter, pain slowly began to fade away. 29 days after the micro-biopsy procedure, the participant was able to recommence participation in all athletic activities. A one-year follow-up confirmed no chronic consequences of the acute hemorrhage/hematoma.Conclusions. The present case report demonstrates that the inadvertent hemorrhaging of a neighboring vessel by percutaneous micro-biopsy procedure can be debilitating. When feasible, to minimize the risk of muscle biopsy-induced hemorrhage/hematoma, we advise ultrasound to identify a biopsy location with minimal risk for arterial bleeding. Post biopsy compression is recommended for up to 15 minutes and post-biopsy follow-up should be completed for up to 72 hours. When there is indication of hematoma development, compression should be applied, and the participant should avoid exercise and physical activity.