Atraumatic acute forearm compartment syndrome due to systemic heparin

A 65-year-old woman was admitted to the hospital for acute heart failure exacerbation. Her history was notable for insulin-dependent diabetes mellitus and mitral valve regurgitation requiring mechanical mitral valve replacement. Found to have mitral paravalvular leak, the patient’s home warfarin was held and heparin infusion was started in preparation for valvular surgery. Eleven days after starting heparin infusion, the patient awoke with severe right forearm pain that worsened throughout the day and by the afternoon had developed decreased sensation at the small finger. Visually, the right forearm had mild swelling and ecchymoses, but was without evidence of traumatic injury, venipuncture, erythema, or fluctuance. On forearm examination, the patient was remarkably tender to palpation over both dorsal and volar compartments, endorsed pain with passive extension of the fingers, and both dorsal and volar compartments were rigid to palpation. The distal compartments of the hand remained soft and non-tender …