The radiological findings in chronic expanding hematoma

Problematic Imaging Diagnostics of Musculoskeletal Gossypiboma with Chronic Expanding Hematoma Mimicking Malignant Lesion

Both musculoskeletal gossypibomas and chronic expanding hematomas have been rarely reported; the reports that do exist are usually case reports. Our objective is to demonstrate problematic imaging diagnostics of an unusual presentation mimicking a malignant lesion. We report the case of a 47-year-old man who underwent bone graft harvesting from the iliac crest for spinal fusion due to scoliosis at 18 years of age, and 29 years later, he developed a growing, painful tumor at the original donor site (a bone defect in the iliac crest). It was challenging to differentiate a hematoma from a malignant tumor based solely on clinical and radiological workup, including an ultrasound-guided needle biopsy focused on viable tissue. The definitive diagnosis of a gossypiboma with a chronic expanding hematoma was based on histopathological assessment after wide surgical resection-a chronic expanding hematoma with multiple foamy macrophages and giant cells engulfing foreign material (original surgical hemostatic sponge).

Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence

Soft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.

Retroperitoneal cystic masses: magnetic resonance imaging features

The objective of this review is to discuss the clinical and histopathologic features, MRI characteristics, and management options of retroperitoneal cystic masses. Radiologists should be familiar with the MR imaging characteristics of retroperitoneal cystic masses to allow for a refined differential diagnosis, assist with lesion management, and prevent unnecessary invasive procedures.

Chronic Expanding Hematoma in the Thigh: A Late Complication 32 Years After Treatment of Synovial Sarcoma: A Case Report

Patient: Female, 49

Final Diagnosis: Chronic expanding hematoma

Symptoms: Thigh swelling

Medication: —

Clinical Procedure: —

Specialty: Orthopedics and Traumatology

The diagnosis and treatment strategy of occipital skull mass in hemophilic patients: a rare case report and literature review

Background

Cranial hemophilic pseudotumor (cHPT) is a very rare disease, which is easy to misdiagnose. It is also difficult to manage such patients. We reported the first case of occipital cHPT.

Case presentation

Here, we presented a rare case of an occipital bone mass in a 3-year-old boy who was diagnosed with hemophilia A. The mass was misdiagnosed as an aneurysmal bone cyst by pathological examination. After resection, the patient underwent one-stage cranioplasty. However, the patient was admitted again for hematoma caused by an invasive procedure. A second surgery and one-stage cranioplasty were performed at the same time. A follow-up 3 months after discharging showed the patient was uneventful, and the titanium mesh was well fixed.

Conclusion

The diagnosis of cHPT requires the combining of history, radiological examination, and pathological examination. Resection is the best choice for symptomatic cHPT. Replacement treatment and less invasive treatment can make perioperative management safer. One-stage cranioplasty for resection of an occipital cHPT can improve the quality of life.

Huge chronic expanding hematoma of the iliac bone following multiple hip surgeries: a case report

Background

Chronic expanding hematoma is a rare entity resulting from trauma or surgery. This condition usually occurs in soft tissue, such as the trunk or extremities, while chronic expanding hematoma arising from bone has not been reported previously. We describe an unusual case of a huge intraosseous chronic expanding hematoma arising from the ilium, which had grown over a 40-year period following hip surgeries.

Case presentation

A 57-year-old Japanese woman presented with a 1.5-year history of right hip pain. She had a history of bilateral developmental dysplasia of the hip and had undergone bilateral arthroplasties in childhood. A physical examination revealed a large, firm, immobile mass at her right ilium. Based on radiographic findings, a type of slow-growing bone tumor was suspected, and an incisional biopsy was performed. A histopathologic examination revealed large amounts of old clotted blood within the lesion, and the capsule of the lesion was composed of dense, fibrous, connective tissue. There was no evidence of neoplasia, and chronic expanding hematoma was suspected. The lesion was resistant to conservative treatment, and so we performed an internal hemipelvectomy (including the capsule of the mass) and a reconstruction by hip transposition 2.5 years after the incisional biopsy. There was no recurrence of chronic expanding hematoma at the most recent follow-up of 1 year and 8 months postoperatively.

Conclusions

A chronic expanding hematoma is characterized by its persistence and increasing size more than 1 month after the trauma or surgical event suspected of causing hemorrhage. To the best of our knowledge, this is the first report of chronic expanding hematoma arising from bone. We performed internal hemipelvectomy and hip transposition, and there has so far been no recurrence. This disease may be considered a differential diagnosis for bone tumor when the patient has a history of surgery or trauma, regardless of how many years have passed since the index event.

Pitfalls in soft tissue sarcoma imaging: chronic expanding hematomas

Solid or nodular enhancement is typical of soft tissue sarcomas although high grade soft tissue sarcomas and those with internal hemorrhage often appear heterogeneous with areas of nonenhancement and solid or nodular enhancement. These MRI findings often prompt an orthopedic oncology referral, a biopsy or surgery. However, not all masses with these imaging findings are malignant. We report the multimodality imaging findings of two surgically proven chronic expanding hematomas (CEH) with imaging features that mimicked sarcomas. A third case of nonenhancing CEH of the lower extremity is also presented as a comparison. It is important that in the correct clinical scenario with typical imaging findings, the differential diagnosis of a chronic expanding hematoma be included in the workup of these patients. An image-guided biopsy of nodular tissue within such masses that proves to be negative for malignancy should not necessarily be considered discordant. A correct diagnosis may prevent a morbid unnecessary surgery and may indicate the need for a conservative noninvasive follow-up with imaging.

Chronic Expanding Hematoma in the Extremities: A Clinical Problem of Adhesion to the Surrounding Tissues

Chronic expanding hematoma is characterized by continuous growth of a blood collection. We analyzed the clinical features of 7 patients with chronic expanding hematomas in the extremities, with an average age of 65.6 years. All lesions occurred in the lower extremities, with 4 seen in the thigh and 3 in the knee region. Six patients had subcutaneous hematomas, while 1 was deep-seated in the thigh. The magnetic resonance features of the lesion were compatible with those of a standard hematoma. A low signal intensity on T1- and T2-weighted imaging at the pseudocapsule was also characteristic. Cystic features were seen in 5 of 7 patients. All lesions were resected together with their pseudocapsule. In the subcutaneous lesions, it was necessary to resect adherent fascia, with or without involved skin. In the deep-seated thigh lesion, the common peroneal nerve was completely adherent to the pseudocapsule, a phenomenon from absence of the common peroneal nerve which appeared after resection. Chronic expanding hematomas of the extremities are predominantly located in the subcutaneous tissue of the lower extremity. The surrounding pseudocapsule is adherent to the adjacent tissues, and clinicians must be aware of this, especially when resecting a deep-seated lesion.

Bizarre soft tissue tumour on the gluteus muscle: a case report of spontaneous chronic expanding haematoma

Chronic expanding haematoma (CEH) is rare and refers to a gradually increasing haematoma that is not absorbed after surgery and trauma. This report highlights unusual mass occurring on the gluteus muscle, and the aim is to indicate the diagnostic method. It is necessary to consider the mechanism of the occurrence and to know the characters of CEH. The patient was a 51-year-old man who had noticed a soft mass on his right hip. The mass had gradually increased to 10 cm in size over the year. CT images revealed a haematoma. However, MRI showed a rare biphasic fluid-fluid layer inside the mass and indicated a different pattern compared with that of a normal haematoma. Because the mass was affecting the patient's social life, and the diagnosis was difficult to confirm, surgical treatment was elected. Intraoperatively, the mass contained a large amount of a brown mud-like substance and showed the bizarre appearance inside. The mass was diagnosed as CEH based on both the clinical findings and the histopathological diagnosis. The patient had no traumatic event and no previous surgery. In the absence of the clinical history and the unique imaging findings, it was difficult to diagnose the mass as CEH. It is important to clarify a patient's underlying disease, history, and lifestyle and to consider any correlation between the mass location and the patient's condition carefully. Considering the character of the mass and the lack of a preoperative definitive diagnosis, we recommend performing complete surgical resection.

Diffusion-weighted imaging in musculoskeletal radiology-clinical applications and future directions

Diffusion-weighted imaging (DWI) is an established diagnostic tool with regards to the central nervous system (CNS) and research into its application in the musculoskeletal system has been growing. It has been shown that DWI has utility in differentiating vertebral compression fractures from malignant ones, assessing partial and complete tears of the anterior cruciate ligament (ACL), monitoring tumor response to therapy, and characterization of soft-tissue and bone tumors. DWI is however less useful in differentiating malignant vs. infectious processes. As of yet, no definitive qualitative or quantitative properties have been established due to reasons ranging from variability in acquisition protocols to overlapping imaging characteristics. Even with these limitations, DWI can still provide clinically useful information, increasing diagnostic accuracy and improving patient management when magnetic resonance imaging (MRI) findings are inconclusive. The purpose of this article is to summarize recent research into DWI applications in the musculoskeletal system.

Chronic Expanding Hematoma in the Popliteal Fossa after Pseudoaneurysm Surgery because of Nail Puncture

Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas (CEH). Magnetic resonance imaging (MRI) is useful for the diagnosis. Total excision with the pseudocapsule is the treatment method. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for CEH. We present a rare case report of a 45-year-old man with a large, painful swelling in his left popliteal fossa. He had a puncture wound by a nail 11 years ago and a gradually expanding mass occurred in his popliteal fossa. A pseudoaneurysm was detected and operated a year later. After surgery, a gradually expanding mass recurred in his popliteal fossa. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. On MRI, an enormous swelling of 115 × 107 × 196 cm in diameter was seen. It was diagnosed as CEH and was excised completely protecting the collateral vessels and there was no recurrence after a year from the surgery.

Organized hematoma developed after suboccipital craniectomy

An organized hematoma shows a heterogeneous signal intensity on T1-and T2-weighted images on MR imaging, reflecting variable stages of hemorrhage. Although rather nonspecific, precontrast CT images of an organized hematoma demonstrate inhomogeneous hyperdense mass with or without calcification. We report a case of an organized hematoma in a 44-year-old man, which developed 5 years after decompressive suboccipital craniectomy following acute cerebellar infarction. To our best knowledge, there has been no report describing organized hematoma in the suboccipital craniectomy site. Computed tomography and magnetic resonance imaging findings of the organized hematoma are shown and discussed. We believe that recognition of the characteristic imaging findings of the organized hematoma as well as consideration of the history of surgery or anticoagulation treatment assists in its correct diagnosis enabling an inappropriate surgery to be avoided.

Chronic expanding hematoma extending over multiple gluteal muscles associated with piriformis syndrome

We report on a patient with an unusual, slowly enlarging hematoma of the left buttock. A 62-year-old man presented with a 6-year history of an enlarging mass of the left buttock. He had first noted the mass 6 years earlier and had had sciatica of the left lower limb for the last 2 months. He denied any history of antecedent trauma. The lesion extended over 3 gluteal muscles (the gluteus medius, gluteus minimus, and piriformis). On microscopic examination, the lesion showed typical signs of chronic expanding hematoma. The sciatica was relieved after surgical removal of the lesion. The lesion had not recurred at the last follow-up 4 years after the operation. The present case suggested that chronic expanding hematoma can extend into multiple muscles due, perhaps, to long-term growth and the anatomical and functional conditions of the affected muscles. Our case also suggests that chronic expanding hematoma can be a cause of piriformis syndrome.

Dilemmas in distinguishing between tumor and the posttraumatic lesion with surgical or pathologic correlation

This article discusses the most common diagnostic dilemmas when trying to distinguish between tumor and sports injury or other trauma. Bone tumors frequently occur in the same young active patients who experience sports injuries. If the pain persists longer than expected, imaging studies should be obtained to prevent a delay in diagnosis or an inappropriate arthroscopy. A history of spontaneous fracture or a fracture after minor trauma should raise suspicion for underlying lesion as the cause. Occasionally necrosis and/or hemorrhage within a soft tissue sarcoma is so extensive that only a small cuff of viable tumor tissue is present.

2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET) findings of chronic expanding intrapericardial hematoma: a potential interpretive pitfall that mimics a malignant tumor

A 77-year-old man who had undergone mitral valve replacement 5 years previously presented with an intrapericardial mass. Computed tomography and magnetic resonance imaging showed that the mass lesion contained hematoma components. Positron-emission tomography (PET) with 2-[¹⁸ F] fluoro-2-deoxy-d-glucose (FDG) revealed uptake in the peripheral rim of the mass. These findings suggested the presence of hematoma associated with a malignant lesion. Surgical resection was performed, and the histological diagnosis was chronic expanding intrapericardial hematoma without neoplastic changes. Chronic expanding intrapericardial hematoma is a rare disease but should be considered when an expanding mass is found in a patient after cardiac surgery. The FDG-PET findings of chronic expanding hematomas, including FDG uptake in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall that mimics a malignant tumor.

Chronic expanding hematoma might be a potential insidious challenge for orthopedic surgeon

Chronic expanding hematomas can cause alarm both to the physician and to the patient because they simulate the growth of a malignant tumor. It is not always possible to bring back the cause to a specific traumatic event that the patient can remember. At this purpose, it is important to have a precise diagnosis when dealing with a growing mass and to exclude any malignancy before processing any treatment. In this article, we report the case of a young patient admitted to our department with a suspected soft tissue sarcoma, but imaging study and histological examination revealed to be hematoma. The authors want to emphasize the necessity of performing a complete clinical and instrumental study when surgeon has to deal with a growing mass. From accurate analysis of imaging, it is often possible to discriminate between malignancy and other benign forms.

Profunda femoris pseudoaneurysm following Birmingham hip resurfacing: an important differential diagnosis for a periarticular cystic mass

Vascular injury following hip resurfacing arthroplasty is rare: we present a case of profunda femoris pseudoaneurysm complicating hip resurfacing arthroplasty performed via an anterolateral approach. Over recent years, it has been recognized that an adverse reaction to metal debris from metal-on-metal arthroplasties can also result in the development of cystic masses around the hip. This case highlights a potential rare differential diagnosis that needs to be considered when imaging cystic mass lesions around the postoperative hip. Imaging can provide a definitive diagnosis if this entity is considered and its appearances recognized, resulting in appropriate management of this potentially limb- and life-threatening complication.

Chronic expanding hematoma of the thigh

Hematomas following surgery or trauma usually resolve without complications. In some instances, for reasons that are not completely understood, hematoma formation is followed by slow expansion of the mass. The large fluid collection is surrounded by a pseudocapsule and fibrous tissue, and present months or years after the original insult, as chronic expanding hematoma. In this case study, we present a rare case of chronic expanding hematoma in an 84-year-old woman. The patient noted a painful swelling in the posteromedial aspect of the lower thigh, and recalled a bump to the left knee 64 years earlier. The lesion was successfully resected, with a preoperative presumptive diagnosis of organized hematoma, although the clinical findings were suggestive of malignancy. We describe the radiological findings, discuss the differential diagnosis.

Imaging features of chronic expanding hematoma in the soft tissues of the hand simulating an aggressive lesion: case report

A chronic expanding hematoma can persist and increase in volume for more than 1 month after the first hemorrhage. It is rare, uncommon in the hand, little known among physicians, and an imitator of malignancy. Our purpose was to report a case of this condition in the soft tissues of an 8-year-old girl's hand that simulated an aggressive lesion, and to conduct a review on this subject.

Extremity soft tissue sarcomas presented as hematomas

INTRODUCTION

Soft tissue sarcoma (STS) with extensive intra-tumoral hemorrhage is an infrequently described entity, usually misdiagnosed as intra-muscular hematoma. The outcomes in this group of patients have not been previously described.

MATERIALS AND METHODS

We retrospectively identified 15 patients, with initial clinical or imaging diagnosis of hematoma, or hematoma versus hemorrhagic sarcoma, although final diagnosis of high-grade STS was established in all cases.

RESULTS

The most common location was the thigh. Three patients had a bleeding predisposition. Ten patients were referred for further evaluation with the initial diagnosis of muscle strain/hematoma, hematoma versus abscess in one, whereas four were referred for soft tissue mass evaluation. Final diagnosis was made by one biopsy in only 53% of patients. Mean time to diagnosis for patients with two biopsies was 7 months from initial presentation. Histologic diagnosis was malignant fibrous histiocytoma in ten patients. Surgical treatment included tumor resection in eleven and amputation in three patients. One patient had lung metastatic disease at presentation and eight developed lung metastases within a median time of 7 months.

CONCLUSION

We suggest that an STS masquerading as hematoma should be suspected when the mechanism and the energy of the trauma do not justify the clinically detected severity of the injury, or the lesion does not follow the expected clinical course of resolution after initial conservative management. Bleeding predisposition does not exclude malignancy. The evacuation of hematomas should include pathologic examination of tissue. Prognosis is dismal due to early metastatic disease.

Extrathoracic protrusion of a chronic expanding hematoma in the chest mimicking a soft tissue tumor

We report an uncommon clinical case of extrathoracic protrusion of a chronic expanding hematoma in the chest, mimicking a soft tissue sarcoma. A 77-year-old Japanese man was successfully treated by chest wall resection and partial decortication of the lung. The postoperative pathology examination confirmed a diagnosis of a granular cell reaction. Details of the clinical and radiographic features are presented.

Spontaneous and enormous, chronic expanding hematoma of the lumbar region: a case report

BACKGROUND

Chronic expanding haematoma (CEH) is a very infrequent event with imprecise developmental mechanism and is rarely reported in literature.

CASE PRESENTATION

We present a case of enormous and spontaneous chronic haematoma of the back, expanded from the lower thoracic area to the sacral area, in a young patient without any history of trauma or chronic coagulopathy.

CONCLUSION

The MRI scan is very useful in preoperative diagnosis, however only the histopathological examination is able to perform the differential diagnosis with soft tissue tumors. Careful surgical treatment is important to minimize the haematoma recurrence.

Ability of diffusion-weighted imaging for the differential diagnosis between chronic expanding hematomas and malignant soft tissue tumors

PURPOSE

To evaluate the potential of diffusion-weighted imaging (DWI) in distinguishing chronic expanding hematomas (CEHs) from malignant soft tissue tumors.

MATERIALS AND METHODS

We performed conventional MRI and DWI of six CEHs and 31 malignant soft tissue tumors from 37 patients seen between May 2000 and November 2006. DWI was obtained with a single-shot echo-planar imaging (EPI) sequence using a 1.5T MR imager. The mean apparent diffusion coefficient (ADC) value was also calculated. We evaluated MRI findings of CEHs and compared ADC value of CEHs with malignant soft tissue tumors.

RESULTS

On conventional MRI, two of six CEHs were difficult to differentiate from malignant soft tissue tumors based on imaging findings. The mean ADC value of CEHs and malignant soft tissue tumors was 1.55+/-0.121x10(-3) mm2/sec and 0.92+/-0.139x10(-3) mm2/sec (mean+/-SD), respectively. The mean ADC value of CEHs was significantly higher than that of malignant soft tissue tumors (P<0.01). There was no overlap in the minimum ADC values among CEHs and malignant soft tissue tumors.

CONCLUSION

DWI is useful for differentiating between CEHs and malignant soft tissue tumors.

'Telangiectatic' transformation in soft tissue sarcomas. a clinicopathology analysis of an aggressive feature of high-grade sarcomas

BACKGROUND

'Telangiectatic' change, which contains a large fluid hemorrhagic component, occurs in a variety of high-grade soft tissue sarcomas.

METHODS

In a retrospective database review, we identified 20 consecutive patients (3%) with 'telangiectatic' change in soft tissue sarcomas.

RESULTS

Tumors were located in the thigh (55%), shoulder (15%), calf (15%), upper arm (10%), and buttock in one patient. All 20 tumors were high grade. Histological diagnoses were MFH (40%), leiomyosarcoma (15%), synovial sarcoma (10%), and one each of seven other sarcomas (35%). Tumor size was often large-more than 10 cm (35%), between 5 and 10 cm (60%), and less than 5 cm in one case. A history of contusion to the tumor site followed by swelling was recorded in 30% of patients and 80% presented with a painful mass. On MRI imaging, 60% of tumors appeared to contain more than 50% blood, 50% had a hemosiderin-laden rim, and 55% had well-defined tumor nodules within the wall of the hematoma. Limb-sparing surgery was carried out in 90% of patients, the other 10% underwent primary amputation. The 5-year, event-free survival rate was 30%. Of the patients, 15% presented initially with metastatic disease; in 53%, it developed within 2 years of diagnosis. The overall local recurrence rate was 30%.

CONCLUSIONS

Telangiectatic transformation in soft tissue sarcomas is a rare feature of aggressive high-grade soft tissue sarcomas and is unique in its clinical presentation, MRI characteristics, pathological pattern, and a tendency for a worse-off prognosis.

Spontaneous giant expanding thigh hematoma mimicking soft tissue neoplasm

We present a case of giant chronic expanding hematoma occurring in the left lateral thigh without any history of trauma or chronic medical disease. In our case, a diagnosis was unable to perform through conventional diagnosis method, which was confirmed by histopathological examination after successful surgical treatment. We suggest that patients who present with slowly growing extremity masses without trauma, in addition to soft tissue sarcoma and malignancy, chronic expanding hematoma should be considered in the differential diagnosis.

Long-standing Morel-Lavallée lesion of the thigh simulating a neoplasm

We report on the case of a 56-year-old man in whom a Morel-Lavallée lesion developed in the thigh. Ultrasound revealed a well-defined thick-walled cystic mass between the hypodermis and fascial planes that in some areas constituted hyperechoic papillar extensions in its wall. Magnetic resonance T(1)-weighted images showed that the mass was well circumscribed and mildly inhomogeneous and had a high signal intensity. On T(2)-weighted images, the mass had mixed signal intensity and a fluid-fluid level. We also discuss both the difficulty in making a differential diagnosis for and the treatment of this lesion.

[Chronic expanding hematoma of the soleus: a case report]

Trauma-induced hematomas of the limbs usually resorb without sequelae. In certain circumstances which are not fully understood, the hematoma may expand progressively, eventually leading to the development of a tumor-like mass in the soft tissues. We report the case of a chronic expanding hematoma observed in the right soleus muscle of a 75-year-old man. The mass grew +9 cm compared with the other side over a period of two to three years with no notion of recent trauma. Surgical biopsy disclosed a thick capsule containing "chocolate pus". Pathology and cytology examination led to the diagnosis of pseudo-tumor calcinosis subsequent to a hematoma which the patient had developed 34 years earlier when as a mountain guide he had experienced a tear of the soleus muscle. Local care required complete resection of the soleus muscle. The patient was able to resume activities without pain. Well described in the literature, encapsulated hematoma of the limbs is not well known in France. This case illustrated the potentially long latency period (34 years in our patient). Pathologically similar to tumor calcinosis, chronic expanding hematoma should be entertained as a possible diagnosis in a patient with a longstanding mass and a history of past trauma. The differential diagnosis with sarcoma is established by magnetic resonance imaging which reveals a peripheral low intensity signal on T1 and T2 sequences.

Long-standing Morel-Lavallée lesion in the proximal thigh: Ultrasound and MR findings with surgical and histopathological correlation

A 65-year-old man presented with a soft mass in his proximal right thigh. Ultrasonography showed a well-defined anechoic lesion with slightly internal echoes. On MRI, the mass was hypointense and minimally hyperintense compared with muscle at T1 and hyperintense at T2, with a hypointense peripheral rim on both sequences. No signal loss was observed on T1-weighted fat-suppression MRI. The clinical setting, imaging findings and histopathological features were consistent with a long-standing Morel-Lavallée lesion.

Chronic expanding hematoma in the psoas muscle

We report an unusual case of chronic expanding hematoma in the psoas muscle. A 53-year-old man was admitted for evaluation of a mass shadow in the left lower lung field on chest X-rays. He had also been suffering from dull left back pain. A computed tomography scan showed a cystic lesion with a rim enhancement in the left retroperitoneal space. Mixed signal intensity in a mosaic pattern was seen on a T2-weighted magnetic resonance image. We could not rule out a suspicion of a neoplastic intratumoral hemorrhage. Due to increased pain and the definite diagnosis, surgery was performed. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The expansion process is thought to be due to the irritant effects of blood and its breakdown products, which cause repeated exudation and bleeding from capillaries in the granulation tissues.

Chronic expanding hematoma in the temporal region

We report a rare case of chronic expanding hematoma in the right temporal region that developed into a large mass during 12 years. The patient, who had a history of blunt trauma in her right temporal region at the age of 4 months, noticed a slowly growing mass at the same site in the last few months. Computed tomography revealed a well-circumscribed subcutaneous tumor. The tumor was completely resected. Histopathologically, this tumor was confirmed in the diagnosis of chronic expanding hematoma.

Chronic expanding hematoma of the thigh simulating neoplasm on gadolinium-enhanced MRI

Patients who present with slowly growing extremity masses are often imaged with MRI to be examined for possible tumors. In addition to cysts and neoplasms, chronic expanding hematomas should be considered in the differential diagnosis if the patient has a history of remote trauma. The presence or absence of internal contrast enhancement is often used to distinguish between hematomas and hemorrhagic neoplasms on MRI and CT. We present the unusual case of a patient who had a chronic expanding hematoma of the calf that demonstrated nodular internal enhancement on gadolinium-enhanced MRI, simulating a neoplasm.

FDG-PET imaging for chronic expanding hematoma in pelvis with massive bone destruction

Chronic expanding hematoma is a rare presentation of a hematoma characterized by a persistent increase in size for more than a month after the initial hemorrhage. We present a 65-year-old man with a chronic expanding hematoma in his ilium who was receiving anticoagulant treatment. The patient had a delayed manifestation of a femoral neuropathy with massive bone destruction. 2-Deoxy-[18F]fluoro-D: -glucose (FDG) positron emission tomography (PET) imaging revealed an increased uptake in the rim of the mass in images acquired 1 h after FDG injection. FDG-PET scans were performed using a dedicated PET scanner (HeadtomeV/SET2400 W, Shimadzu, Kyoto, Japan), and the PET data for the most metabolically active region of interest (ROI) were analyzed. The maximum standardized uptake value (SUVmax) was set to a cut-off point of 3.0 to distinguish between benign and malignant lesions. The SUVmax of the patient's lesion was 3.10, suggesting a malignant lesion. The characteristics of FDG-PET images of chronic expanding hematomas, including the uptake of FDG in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall in mimicking a sarcoma.

Chronic expanding hematoma in the temporal region

A rare case of chronic expanding hematoma in the right temporal region that developed into a large mass over the course of 12 years is reported. The patient, who had a history of blunt trauma to her right temporal region at the age of 4 months, noticed a slowly growing mass at the same site over the last few months. Computed tomography revealed a well-circumscribed subcutaneous tumor. The tumor was completely resected. Histopathologically, the diagnosis of chronic expanding hematoma was confirmed.

Calcific myonecrosis: a report of ten new cases with an emphasis on MR imaging

The aim of this study is to report the typical radiographic and MR imaging features of calcific myonecrosis, which help to distinguish this rare entity from other causes of a calcifying calf mass. Ten patients with a final diagnosis of calcific myonecrosis were referred to a specialist orthopaedic oncology service in a 5-year period with the presumptive diagnosis of malignancy based on recent clinical presentation and imaging findings. Radiographs were available for retrospective review in all ten cases and MR imaging in six. All patients presented with a slow-growing painless calf mass. All gave a history of major trauma to the lower leg many years before, but in only two cases did the referring clinician query whether trauma might be a contributory factor. Radiographs showed well-defined fusiform mineralised masses up to 25 cm in length arising within the calf. The calcification was consistently peripheral and plaque-like. Ossification was not present. MR imaging showed the anterior compartment to be involved in four cases and all compartments in two. T1- and T2-weighted images showed peripheral low signal intensity, more prominent on the T2-weighted images, because of the peripheral mineralization. The contents of the masses were variable on T1-weighted images depending on the differing amounts of blood breakdown products and were heterogeneous on T2-weighted images. The latter may be explained by a combination of the mineralisation and T2 shortening due to blood breakdown products. A gadolinium chelate, administered in two cases, failed to show any appreciable enhancement. Calcific myonecrosis has characteristic clinical, radiographic and MR features that should make the condition easy to recognise. Despite its rarity, it should be included in the differential diagnosis of focal mineralisation of the calf.

Adrenal adenoma with organizing hematoma: diagnostic dilemma at MRI

We report a case of adrenal adenoma with organizing hematoma mimicking hemangioma on magnetic resonance imaging (MRI). The lesion demonstrated heterogeneous hyperintensity on heavily T2-weighted images. On dynamic contrasted-enhanced MRI, the lesion demonstrated early, patchy peripheral enhancement with subsequent fill-in that persisted. Chemical shift gradient-echo images failed to demonstrate the presence of intracellular lipid. Magnetic resonance imaging failed to characterize the lesion, and an erroneous preoperative diagnosis of adrenal hemangioma was made. Although the MRI findings reflected the organized hematoma with abundant vascular spaces, our case emphasizes the point that the MRI characteristics of intratumoral hemorrhage may overlap with those of adrenal hemangioma and chronic expanding hematoma.

Case report: chronic expanding hematoma in the adrenal gland with pathologic correlations

We report a case of chronic expanding hematoma in the adrenal gland. Mixed signal intensity in a mosaic pattern was seen on T2-weighted images. A focal area suggesting a subacute hematoma was also noted. The dynamic CT scan showed heterogeneous contrast enhancement in the arterial phase and heterogeneous spread of the enhanced area within the tumor. Awareness of this finding may prevent the misdiagnosis of a tumor as a neoplastic intratumoral hemorrhage.

Soft tissue sarcoma mimicking chronic hematoma: value of magnetic resonance imaging in differential diagnosis

We report six patients with soft tissue sarcoma mimicking traumatic hematoma. The lesions in these patients, showed huge hematomas and were characterized by rapid growth. Cytology of percutaneous; aspiration biopsy samples was performed in all six patients; however, in five patients, findings for malignant cells were negative. Consequently, they were misdiagnosed, resulting in a poor prognosis. We conducted a retrospective study in which we evaluated the clinical findings, the magnetic resonance (MR) images, and computed tomography (CT) scans of the soft tissue sarcomas forming huge hematomas in the lesion. MR imaging revealed the fine tumor mass with enhancement and characterized the hematoma in the lesion in a more precise fashion than did CT. We conclude that MR imaging is a suitable method for differentiating these soft tissue sarcomas from chronic traumatic hematoma.