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Kucera T, Prokes L, Soukup J, Brtkova J, Valtr O, Sponer P. Problematic Imaging Diagnostics of Musculoskeletal Gossypiboma with Chronic Expanding Hematoma Mimicking Malignant Lesion. Diagnostics (Basel) 2023; 13:diagnostics13091592. [PMID: 37174983 PMCID: PMC10178055 DOI: 10.3390/diagnostics13091592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/14/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
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).
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Affiliation(s)
- Tomas Kucera
- Department of Orthopedic Surgery, University Hospital in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
- Charles University, Faculty of Medicine in Hradec Kralove, Simkova 870, 500 03 Hradec Kralove, Czech Republic
| | - Libor Prokes
- Department of Orthopedic Surgery, University Hospital in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Jiri Soukup
- Charles University, Faculty of Medicine in Hradec Kralove, Simkova 870, 500 03 Hradec Kralove, Czech Republic
- The Fingerland Department of Pathology, University Hospital in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Jindra Brtkova
- Department of Radiology, University Hospital in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Ondrej Valtr
- Department of Orthopedic Surgery, University Hospital in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
| | - Pavel Sponer
- Department of Orthopedic Surgery, University Hospital in Hradec Kralove, Sokolska 581, 500 05 Hradec Kralove, Czech Republic
- Charles University, Faculty of Medicine in Hradec Kralove, Simkova 870, 500 03 Hradec Kralove, Czech Republic
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Yamamuro Y, Kabata T, Takeuchi A, Kajino Y, Inoue D, Ohmori T, Yoshitani J, Ueno T, Ueoka K, Taninaka A, Kataoka T, Saiki Y, Tsuchiya H. Large intraosseous chronic expanding hematoma after total hip arthroplasty presenting with chronic disseminated intravascular coagulation: a case report and literature review. BMC Musculoskelet Disord 2022; 23:609. [PMID: 35739487 PMCID: PMC9229750 DOI: 10.1186/s12891-022-05571-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 06/21/2022] [Indexed: 12/02/2022] Open
Abstract
Background A chronic expanding hematoma (CEH) is a rare complication caused by surgery or trauma; it mostly affects the soft tissues, such as those in the trunk or extremities. We present the first case of a large intraosseous CEH presenting with chronic disseminated intravascular coagulation (DIC), 22 years after total hip arthroplasty (THA); the CEH was treated with a single-stage excision and revision THA. Case presentation A 67-year-old man presented to our hospital with left thigh pain and an enlarging mass. He had no history of trauma, anticoagulant use, or a collagen vascular disorder. The patient initially declined surgery. Two years later, radiographs and computed tomography images revealed progressive osteolysis, marginal sclerosis, and calcification in the left femur, in addition to loosening of the femoral component. Laboratory data revealed anemia and chronic DIC of unknown causes. Magnetic resonance imaging revealed a “mosaic sign” on the mass, indicating a mix of low- and high-signal intensities on T2-weighted images. Needle biopsy prior to surgery revealed no infection or malignant findings. An intraosseous CEH was suspected due to extensive osteolysis and loosening of the femoral component. No other factors that could induce chronic DIC were identified, such as sepsis, leukemia, cancer, trauma, liver disease, aneurysms, or hemangiomas. Therefore, we speculated that the anemia and chronic DIC were caused by the large intraosseous CEH. A single-stage revision THA with surgical excision was performed to preserve the hip function and improve the chronic DIC. The postoperative histopathological findings were consistent with an intraosseous CEH. The anemia and chronic DIC improved after 7 days. There was no recurrence of intraosseous CEH or chronic DIC at the 6-month follow-up. The left thigh pain improved, and the patient could ambulate with the assistance of a walking frame. Conclusions The loosening of the femoral component caused persistent movement, which may have caused intraosseous CEH growth, anemia, and chronic DIC. It is important to differentiate CEHs from malignant tumors with hematomas. Furthermore, the “mosaic sign” noted in this case has also been observed on magnetic resonance images in other cases of CEH.
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Affiliation(s)
- Yuki Yamamuro
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Akihiko Takeuchi
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takuro Ueno
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Ken Ueoka
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Atsushi Taninaka
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoyuki Kataoka
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshitomo Saiki
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Kanazawa University, Takaramachi 13-1, Kanazawa, Ishikawa, 920-8641, Japan
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Yamashita A, Takeda Y, Fukui T, Tachibana T, Fukunishi S. Revision Total Hip Arthroplasty due to Catastrophic Osteolysis Caused by Massive Chronic Expanding Hematoma. Arthroplast Today 2021; 11:32-37. [PMID: 34458531 PMCID: PMC8377491 DOI: 10.1016/j.artd.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/12/2022] Open
Abstract
An 84-year-old woman who underwent bilateral cementless total hip arthroplasty (THA) for dysplastic osteoarthritis 22 years ago was subjected to analysis. A huge soft-tissue mass was revealed in her left medial thigh. Plain radiographs of the left hip joint revealed severe osteolysis around the stem, cup, and ischium. Magnetic resonance imaging showed a 25 × 14-cm multilobulated mass with a thick-walled pseudocapsule. Two-stage surgery was performed with resection of the mass followed by a subsequent revision THA. The mass was diagnosed as a chronic expanding hematoma through gross and histologic findings. Two years after the revision THA, there was no recurrence of a hematoma. Two-stage revision THA was useful for definitive diagnosis, and good functional recovery was obtained after surgery.
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Affiliation(s)
- Akihiro Yamashita
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, Japan
| | - Yu Takeda
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, Japan
| | - Tomokazu Fukui
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, Japan
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Morishita M, Hara H, Katayama E, Kawamoto T, Fukase N, Takemori T, Fujiwara S, Nishida K, Kuroda R, Akisue T. Huge chronic expanding hematoma of the iliac bone following multiple hip surgeries: a case report. J Med Case Rep 2018; 12:265. [PMID: 30176925 PMCID: PMC6122718 DOI: 10.1186/s13256-018-1783-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Masayuki Morishita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Etsuko Katayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Division of Orthopaedic Surgery, Kobe University International Clinical Cancer Research Center, 1-5-1 Minatojimaminami-cho, Chuo-ku, Kobe, 650-0047, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshiyuki Takemori
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shuichi Fujiwara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10- 2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
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