The Hemorrhage that Wasn’t: Polycythemia Presenting as a Pseudointracranial Hemorrhage in Pedestrian vs Automobile Trauma Alert

Abstract

Introduction: Although polycythemia vera is rarely seen, absolute polycythemia is seen more frequently and can drasticallychange 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 patientinitially diagnosed with acute subarachnoid and subdural hemorrhages. Further examination of the imaging and later serumlaboratory findings demonstrated a primary diagnosis of absolute polycythemia, which was an incidental diagnosis thatresulted in the patient’s care team and disposition being changed.Conclusion: Absolute polycythemia is not uncommon, and its causes vary from congenital and myeloproliferative disordersto chronic obstructive pulmonary disease and sleep apnea. It can cause pseudoenhancement in noncontrast computedtomography (CT) scans because of the increased protein level in the blood, and emergency physicians should consider alldifferential diagnoses of pseudoenhancement.