Case of gluteal haematoma in the setting of dual antiplatelet overlapping with tumoural calcinosis of the hip.

To cite: Abdalla A, Dawood T, Bachuwa G. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2017219349 DESCRIPTION A woman aged 40 years with medical history of end-stage renal disease (ESRD) on haemodialysis. Eight months earlier to this presentation, she underwent coronary angioplasty with two drug-eluting stents due to myocardial infarction. She had been on aspirin and ticagrelor since that time. She presented to the emergency department with severe sudden-onset left hip pain. She did not recall any trauma or any precipitating factors. She had severe tenderness around her left hip joint with marked decreased range of movement. There was no visible ecchymosis or bruises on examination. The left hip joint X-ray (figure 1) showed calcified mass overlying the posterior and lateral aspects of the left greater trochanter consistent with tumoural calcinosis. Besides tumoural calcinosis within the left greater trochanteric bursa, MRI of the left hip joint also showed large left gluteal haematoma 16×9×5.6 cm with diffuse oedematous changes involving gluteal musculature (figures 2 and 3). The patient had haemodialysis after the MRI to prevent systemic fibrosis. Laboratory testing showed secondary hyperparathyroidism with hyperphosphataemia. The patient was treated conservatively with analgesia and withholding antiplatelet therapy. As she had already completed 8 months of dual antiplatelet, ticagrelor was discontinued and aspirin was resumed after her pain resolved. The patient was discharged on phosphate binders. Tumoural calcinosis is a rare disease characterised by calcium deposition in periarticular spaces. Secondary tumoural calcinosis is usually due to ESRD. It is usually a radiological diagnosis and