Spontaneous giant expanding thigh hematoma mimicking soft tissue neoplasm

A Masquerading Hematoma Resulting in the Delayed Diagnosis of a Soft Tissue Sarcoma: A Case Report

A 27-year-old male with insidious right arm swelling was diagnosed with a hematoma secondary to a partial biceps tear, later identified as a rhabdomyosarcoma. Soft tissue sarcomas (STS) may present with misleading patient histories and nonspecific symptoms, resulting in misdiagnosis and delayed treatment. One of the classic masqueraders of soft tissue sarcomas is hematomas secondary to trauma. Obtaining a prudent history with careful scrutiny of appropriate imaging often helps establish the correct diagnosis. Ultimately, tissue biopsy can resolve any ambiguous cases and prevent delays in diagnosis and treatment.

Onset of Chronic Expanding Hematoma 25 Years After Total Hip Arthroplasty

Chronic expanding hematoma (CEH) is a rare anatomical condition that gradually expands due to trauma or surgery. We report the case of a 56-year-old woman who developed CEH 25 years after metal-on-polyethylene total hip arthroplasty. She presented with swelling and radiating pain in the right inguinal region. Tocilizumab was administered for treating rheumatoid arthritis and renal amyloid A amyloidosis. Diagnostic imaging and partial resection revealed a soft tissue mass and a CEH, respectively. The symptoms recurred 6 months later; dialysis was initiated, and the CEH was resected under general anesthesia, leading to improvement. This case report emphasizes the importance of prompt diagnosis and intervention in CEH management for preventing further complications and improving the patient's quality of life.

Rhabdomyosarcoma presenting as intramuscular haematoma due to brachioradialis tear after trauma

A man in his 40s with a history of neurofibromatosis type 1 presented to the emergency department with worsening anterior elbow pain and swelling after falling from a chair 2 months prior. An X-ray showed soft tissue swelling without fracture and the patient was diagnosed with a rupture of the biceps muscle. MRI of the right elbow showed a brachioradialis tear with a large haematoma along the humerus. This was initially thought to be a haematoma; therefore, wound evacuation was done twice. When the injury failed to resolve, a tissue biopsy was performed. This revealed a grade 3 pleomorphic rhabdomyosarcoma. It is important to consider malignancy in the differential diagnosis with rapidly growing masses even if the initial presentation is suggestive of a benign condition. Neurofibromatosis type 1 is also associated with a higher risk of malignancy than the general population.

Telangiectatic soft tissue sarcoma and chronic expanding haematoma: a comparative review of MRI features

Soft tissue sarcomas containing a dominant component of haemorrhage are known to be aggressive tumours associated with a poor prognosis. Importantly, the clinical behaviour and imaging characteristics of extensively haemorrhagic soft tissue sarcomas (also termed telangiectatic soft tissue sarcomas) can resemble those of benign haematomas, particularly those that continue to expand over a prolonged period, so-called chronic expanding haematomas (CEH). The following review evaluates the current literature to identify the clinical, imaging and pathological characteristics of telangiectatic soft tissue sarcomas and to determine features that may help distinguish them from CEH. Ultimately, we suggest that lesions with sizeable regions of internal haemorrhage should be regarded with a high degree of suspicion for underlying malignancy and require referral to a tertiary sarcoma centre, where a carefully planned approach to biopsy and follow-up is needed to avoid errors in diagnosis.

Chronic Expanding Hematomas That Occurred 20 Years or More After Primary Total Hip Arthroplasty: A Report of 2 Cases

CASE

We report 2 patients who developed chronic expanding hematomas (CEHs) more than 20 years after ceramic-on-polyethylene total hip arthroplasty (THA). One CEH occurred after a minor fall, and the other appeared with no obvious injury. Neither of the 2 was on anticoagulation. Each caused extensive osteolysis.

CONCLUSION

The only 2 previously reported post-THA cases of CEH involved metal-on-metal THAs and occurred several years after the index THA. Our patients show that CEH also can occur after ceramic-on-polyethylene THA, even after an uneventful clinical course of more than 20 years. Complete removal of both hematoma stopped osteolytic progression, with no recurrence to date.

Spontaneous hematoma of the thigh associated with antiproteinase-3 antibody in a patient with metastatic squamous cell carcinoma treated with nivolumab

We report an unusual case of spontaneous intramuscular hematoma associated with antiproteinase 3 antibody in a patient with metastatic squamous cell carcinoma receiving nivolumab and the medical literature is reviewed.

Chronic expanding hematoma of the left flank mimicking a soft-tissue neoplasm

Soft-tissue hematomas are a common clinical entity often associated with trauma, surgery, and bleeding disorders. In the majority of cases, soft-tissue hematomas acutely appear and spontaneously resolve, but sometimes, they present as swellings that slowly expand and progressively increase with time.

We present a case of a 70-year-old man with chronic expanding hematoma of the left flank without any history of recent trauma or other medical disease.

The diagnosis could not be confirmed on imaging features alone, so the patient was taken to surgery for open biopsy and excision.

In patients with slowly growing extremity masses without recent trauma or chronic medical disorders, the differential diagnosis becomes challenging, and chronic expanding hematoma should be considered in addition to soft-tissue sarcomas and other malignancies.

A Clinicopathological Analysis of Soft Tissue Sarcoma with Telangiectatic Changes

Background. Soft tissue sarcoma with a hemorrhagic component that cannot be easily diagnosed by needle biopsy is defined here as soft tissue sarcoma with telangiectatic changes (STST). Methods. We retrospectively reviewed clinicopathological data of STST from 14 out of 784 patients (prevalence: 1.8%) with soft tissue sarcoma. Results. Tumors were found mostly in the lower leg. Histological diagnoses were undifferentiated pleomorphic sarcoma (n = 5), synovial sarcoma (n = 5), epithelioid sarcoma (n = 2), and malignant peripheral nerve sheath tumor and fibrosarcoma (n = 1). No history of trauma to the tumor site was recorded in any patient. Needle aspiration transiently reduced the tumor volume, but subsequent recovery of tumor size was observed in all cases. Out of 14 patients, 9 presented with a painful mass. MRI characteristics included intratumoral nodules (64.3%). The local recurrence rate was 14.3%, and the 2-year event-free survival rate was poorer (50%) than that of most sarcomas. Conclusions. STST is unique in its clinicopathological presentation. Painful hematomas without a trauma history, intratumoral nodules within a large hemorrhagic component, and subsequent recovery of tumor size after aspiration are indicative of the presence of STST.

Differentiation of Benign Fluid Collections from Soft-Tissue Sarcomas on FDG-PET/CT

OBJECTIVE

To assess the diagnostic performance of (18)F-FDG PET-CT in differentiating soft tissue sarcomas (STSs) from benign fluid collections (BFs).

MATERIALS AND METHODS

Four readers independently reviewed 100 lesions on (18)F-FDG PET-CT and subjectively classified each lesion as an STS or BF and scored the spatial pattern of (18)F-FDG avidity (SP) of each on a 4-point ordered scale (thin, moderate, thick, solid).

RESULTS

Subjective assessment by readers allowed sensitive (91%-98%) differentiation of STSs from BFs, with lower specificity (59%-91%). The STSs had significantly higher SUVmax (median 10.7, range: 2.0-33.7) than BFs (median 2.8, range: 1.1-12.3). Reader agreement in assessment of SP had average κ = 0.61 (range 0.46-0.70). Classification of thick or solid SP as STS yielded an inter-reader averaged sensitivity and specificity of 69% and 98%, respectively. The presence of thick or solid SP resulted in 14.1-fold increase in partial odds of STS. Each unit increase in SUVmax resulted in 1.35-fold increase in partial odds of STS. The receiver operating characteristic (ROC) curves and 95% intervals for SUVmax alone and SUVmax + SP overlapped. The average subjective assessments for the four readers and estimated performance of using SP alone were both contained within the 95% intervals of the two ROC curves.

CONCLUSIONS

(18)F-FDG PET-CT is a sensitive modality for differentiating STSs from BFs. SUVmax and SP are significantly associated with STS. Classification schemes based upon SUVmax alone or augmented with SP can be useful for distinguishing STS from BF.

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.

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.

Chronic expanding hematoma of the lateral thigh and massive bony destruction after a failed total hip arthroplasty

Pseudotumors have been described around both stable and failed total hip arthroplasties. The causes are varied and include polyethylene debris and masses associated with metal-on-metal bearings. We present a patient with a massive tumor of the thigh that grossly and pathologically was associated with recurrent bleeding and extensive bony destruction. The characteristics of this tumor most resemble those of a chronic expanding hematoma. To our knowledge, this has not previously been reported in association with a total hip arthroplasty.

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.