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Kiu A, Yang I, Fung T, Jaffer R, Martin MH. Pseudotumour: an uncommon complication of severe haemophilia. BJR Case Rep 2024; 10:uaae019. [PMID: 38957307 PMCID: PMC11216753 DOI: 10.1093/bjrcr/uaae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 07/04/2024] Open
Abstract
Pseudotumours are uncommon complications of haemophilia, occurring in 1%-2% of patients with haemophilia.1 , 2 It is a slowly expanding haematoma as a result of recurrent haemorrhage, surrounded by a fibrous capsule. It can occur in both bone and soft tissue, and progressive enlargement may result in bone destruction and/or muscle and skin necrosis. Pseudotumours by themselves are usually painless though its mass effect can result in nerve compression resulting in pain or neurologic symptoms. It may also predispose to pathologic fractures (as in our case) and superimposed infections.2 , 3.
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Affiliation(s)
- Alex Kiu
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Isaac Yang
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Tiffany Fung
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Rehana Jaffer
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Marie-Helen Martin
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
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2
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Wang Y, Lv Z, Dong X, Feng B, Weng X. Surgical treatment of a distal radius and ipsilateral metacarpal hemophilic pseudotumor without recurrence or functional deficit: a case report. Front Pediatr 2023; 11:1053368. [PMID: 37325356 PMCID: PMC10266415 DOI: 10.3389/fped.2023.1053368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Distal hemophilic pseudotumor (HP) occurring distal to the wrist appear to be secondary to intraosseous hemorrhage, which develops rapidly and should be treated primarily with long-term replacement therapy and cast immobilization. Surgical removal or even amputation is indicated when conservative management fails to prevent progression. Here, a practical strategy was described for those patients who cannot afford the cost of routine coagulation factor replacement therapy, namely immediate surgical curettage and bone grafting as well as continuous follow-up. Case description A 7-year-old boy with a history of mild hemophilia A was admitted to our medical center because of a 2-year history of progressive swelling and pain around right forearm and hand. Coagulation factor VIII level was 11.1% of normal with no inhibitor. Radiographs revealed expansile swelling, bone destruction, and deformity of the distal right radius and the second metacarpal bone. He was diagnosed with distal HP. Surgical procedure of curettage and bone grafting was performed. The function and appearance of the right wrist were almost normal without discomfort at the 101-month follow-up. Significantly, the same patient was hospitalized again because of a year-long progressive swelling and pain around the left hand when he was 14 years old. X-ray showed multiple bone destruction of the left proximal phalanges of left thumb, middle finger and little finger with local pathological fractures. Surgical procedure of HPs including curettage and bone grafting was performed. Postoperative recovery was good, and the last clinical follow-up at 18 months after the operation displayed a satisfactory shape and functional outcomes. Conclusions Curettage and bone grafting prove to be safe and feasible for patients with distal HP and continuous follow-up of patients with distal HP is very vital for timely finding and then treating successive HP in developing countries.
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Affiliation(s)
- Yingjie Wang
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Zehui Lv
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xiying Dong
- Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Feng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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3
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Li Z, Xiao K, Chang X, Zhou X, Bian Y, Zhang B, Liu Y, Gao P, Feng B, Weng X. A Novel Surgical Classification for Extremity and Pelvic Hemophilic Pseudotumors: The PUMCH Classification. J Bone Joint Surg Am 2023; 105:630-637. [PMID: 36706193 DOI: 10.2106/jbjs.22.00781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND A hemophilic pseudotumor (HPT) is a rare and challenging complication of hemophilia for which there is no classification system that provides uniformity of descriptions or that can be used to guide management. We have developed such a classification based on anatomical site, HPT severity, and corresponding surgical treatment. METHODS The PUMCH (Peking Union Medical College Hospital) classification was developed on the basis of clinical manifestations and imaging features. Extremity and pelvic HPTs were divided into 4 types and 6 subtypes according to anatomical site and whether or not there was destruction of adjacent bone. Associations between the PUMCH classification and surgical treatment, preoperative comorbidities, operative time, intraoperative bleeding, and postoperative complication rates were analyzed. RESULTS Forty-five patients with 53 HPTs that were treated at PUMCH between December 2005 and October 2021 were included. The mean age at the time of surgery was 35.4 ± 11.9 years, and the median follow-up duration was 60.3 months. Twenty-eight HPTs were classified as type I (13 IA, 7 IB, 8 IC); 3, as type II; 6, as type III; and 16, as type IV. All 20 type-IA and IB HPTs were treated with excision, and the 3 type-II HPTs were treated with curettage and bone grafting. Fourteen type-IV pelvic HPTs underwent excision, 2 of which needed concomitant pelvic reconstruction. Six type-IC HPTs and 1 type-III HPT underwent excision and osseous reconstruction. Amputation was required for 1 type-IC and 3 type-III HPTs. Type-IC HPTs had the longest mean operative time (194.3 ± 28.2 minutes) and the greatest intraoperative bleeding (2,000 mL [interquartile range, 1,100 to 3,000 mL]). Postoperative infection was more common in patients with type-III (50.0%) and type-IC (28.6%) HPTs, but not significantly so. CONCLUSIONS The PUMCH classification is based on the anatomic pathology and surgical strategy for HPTs. The classification of HPTs corresponds to surgical outcomes, and may be helpful for decision-making regarding their surgical treatment. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ziquan Li
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Ke Xiao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiao Chang
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xi Zhou
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yanyan Bian
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Baozhong Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yong Liu
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Peng Gao
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Bin Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Xisheng Weng
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China.,State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
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4
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Ray A, Colville JG, Hartley R, Rowbotham E. The musculoskeletal manifestations of haemophilia: a review of the imaging findings. Clin Radiol 2022; 77:730-737. [PMID: 35985846 DOI: 10.1016/j.crad.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 11/26/2022]
Abstract
Haemophilia is a common hereditary cause of bleeding diathesis and the musculoskeletal system is frequently affected. Repeated episodes of haemarthrosis initiate a cascade towards haemophilic arthropathy, a disabling and deforming joint disease with both degenerative and inflammatory features, which include articular cartilage loss, bone erosions, and synovitis. Haemophilic pseudotumour and intra-muscular haematoma make up the remainder of the musculoskeletal manifestations of this systemic condition. Radiological assessment is vital in the assessment and follow-up of these haemophilic complications and MRI is the reference standard. This article summarises the radiological findings relevant to the diagnosis and monitoring of this complex patient group.
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Affiliation(s)
- A Ray
- Department of Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK.
| | - J G Colville
- Department of Radiology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - R Hartley
- Department of Radiology, The James Cook University Hospital, South Tees NHS Trust, Middlesbrough TS43BW, UK
| | - E Rowbotham
- Department of Radiology, Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Chapel Town Road, Leeds LS7 4SA, UK
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5
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Cumsky JL, Nguyen BD. PET/CT Imaging of Hemorrhagic Pseudotumor Arising From Treated Plasmacytoma. Clin Nucl Med 2022; 47:e565-e567. [PMID: 35439181 DOI: 10.1097/rlu.0000000000004233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hemorrhagic pseudotumor occurs in approximately 1% to 2% of patients with hemophilia. This lesion is exceptionally rare in nonhemophiliac individuals. The authors present a case of treated right ischial plasmacytoma with a progressively enlarging expansile hemorrhagic pseudotumor, documented on 18 F-FDG PET/CT and MRI and confirmed by histology.
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6
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Risk Factors for Amputation in the Surgical Treatment of Hemophilic Osteoarthropathy: A 20-Year Single-Center Report. Pain Res Manag 2022; 2022:1512616. [PMID: 35386858 PMCID: PMC8979685 DOI: 10.1155/2022/1512616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/28/2022] [Accepted: 02/23/2022] [Indexed: 12/19/2022]
Abstract
Purpose Hemophilic osteoarthropathy (HO) is a common cause of spontaneous bleeding in hemophiliacs. Surgical procedures are necessary for patients with severe HO. As a last resort, amputation is sometimes needed to treat complex HO cases. This study aimed to review the existing records of patients who underwent amputations in HO surgical treatment, summarize the risk factors, and provide relevant references for surgeons. Methods We retrospectively reviewed the records of hemophilic patients received surgeries at Peking Union Medical College Hospital between 2000 and 2020. The amputation patients without neoplasm or acute trauma were screened out. Patient information was extracted from medical records. A literature retrieval of hemophilic amputation cases was conducted via PubMed. The risk factors of amputation were summarized and analyzed via descriptive statistics and Fisher's precision probability test. Results Four male hemophilia A patients out of 201 patients underwent lower limb amputation. The reasons of amputation contained severe pseudotumor with factor inhibitor and large bone defects, recurrent pathological fracture with pseudotumor, skin ulcer with chronic osteomyelitis, and pseudotumor with systematic infection. In cases reported in retrieved literature, severe pseudotumor with complications, bacterial infection and factor inhibitor were common factors. Discussion. As the first study on amputations in HO patients, we found that severe hemophilic pseudotumor, chronic bacterial infection, and coagulation factor inhibitor was potential risk factors for amputation. Sufficient factor replacement therapy is fundamental in the prevention of amputation. The early diagnosis and specially designed surgical techniques could improve the rate of limb salvage.
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Abstract
Incidental bone lesions are encountered frequently in day-to-day practice. Many of these lesions are indeterminate requiring referral to specialist centres for further characterisation with or without biopsy; however, as biopsy has its own drawbacks, not all lesions can be subjected to biopsy. The primary role of a radiologist in these situations is to characterise these lesions based on their imaging appearances into aggressive lesions requiring biopsy and non-aggressive lesions that do not require a biopsy. The term "do-not-touch lesion" is used to describe a lesion with typical radiographic appearances that can be characterised based on radiographic appearances alone without needing a biopsy. With recent advances in imaging, many incidental lesions can be characterised into do-not-touch lesions based on their imaging appearances alone using a single imaging technique or using a combination of imaging techniques and, less frequently, with the additional help of serological investigations, without the need for biopsy. Hence, the definition of do-not-touch lesions of bone needs a revisit. In this article, we attempt to redefine do-not-touch lesions of bone and propose an imaging-based classification for characterisation of these lesions.
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8
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Haemophilic Pelvic Pseudotumour: A New Surgical Option. Healthcare (Basel) 2021; 9:healthcare9101269. [PMID: 34682949 PMCID: PMC8536013 DOI: 10.3390/healthcare9101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Haemophilia is an inherited coagulopathy caused by the absence or dysfunction of clotting factor VIII or IX. Clinical manifestations are generally secondary to recurrent bleeding episodes mainly in the musculoskeletal system. Bleeding symptoms appear early in life and, when the disease is severe (when plasma factor VIII or IX activity is <1% of normal), joint and muscle bleeding may occur spontaneously. A pseudotumour is a recurrent, chronic, encapsulated, slowly expanding, muscle hematoma. Haemophilic pseudotumour is a rare complication of haemophilia which occurs, as a condition either from repeated spontaneous bleeding or coming from a traumatic origin, in 1–2% of haemophilic patients. Case report: A 32-year-old man with severe haemophilia A referred to our Clinic with a massive right iliac wing pseudotumour complicated by Staphylococcus aureus superinfection and skin fistulisation. In this report we describe the medical management and surgical treatment by the adoption of a novel surgical technique which involves the use of a pedicle-screw and rod system (PSRS), a polyglycolic acid MESH and bone cement in order to build up an artificial ilium-like bony mass. This case report highlights the importance of interdisciplinary approach and the efficacy of eradicating surgery as treatment, especially in the case of large and long-lasting lesions.
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9
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Guimaraes JB, Masson R, Petrilli M, de Seixas Alves MT, Lederman H. Correction to: Painful left forearm swelling. Skeletal Radiol 2021; 50:459-461. [PMID: 33029647 DOI: 10.1007/s00256-020-03613-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Julio Brandão Guimaraes
- Department of Radiology, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Sao Paulo, Brazil. .,Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil. .,Musculoskeletal and Quantitative Imaging Research Group (MQIR), Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
| | - Renato Masson
- Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Marcelo Petrilli
- Department of Orthopedic Surgery, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Sao Paulo, Brazil
| | | | - Henrique Lederman
- Department of Radiology, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Sao Paulo, Brazil.,Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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10
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Guimaraes JB, Masson R, Petrilli M, de Seixas Alves MT, Lederman H. Painful left forearm swelling. Skeletal Radiol 2021; 50:457-458. [PMID: 32829422 DOI: 10.1007/s00256-020-03591-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Julio Brandão Guimaraes
- Department of Radiology, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Sao Paulo, Brazil. .,Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil. .,Musculoskeletal and Quantitative Imaging Research Group (MQIR), Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
| | - Renato Masson
- Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - Marcelo Petrilli
- Department of Orthopedic Surgery, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Sao Paulo, Brazil
| | | | - Henrique Lederman
- Department of Radiology, Grupo de Apoio ao Adolescente e à Criança com Câncer (GRAACC), Sao Paulo, Brazil.,Department of Radiology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
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11
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Gobert D, Patey N, Doyon J, Kalin-Hajdu E. Mesenchymal chondrosarcoma of the orbit masquerading as a hemophilic pseudotumor. Orbit 2020; 40:431-434. [PMID: 32835558 DOI: 10.1080/01676830.2020.1812093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
An 11-year-old boy presented with a lesion of the right orbit that was thought to be a hemophilic pseudotumor. Excisional biopsy revealed an unexpected diagnosis of mesenchymal chondrosarcoma. Both mesenchymal chondrosarcoma and hemophilic pseudotumor of the orbit are exceedingly rare. To the best of our knowledge, this is the first reported case of orbital mesenchymal chondrosarcoma masquerading as hemophilic pseudotumor.
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Affiliation(s)
- Delphine Gobert
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Natalie Patey
- Department of Pathology, Université de Montreal, Montreal, Quebec, Canada
| | - Josée Doyon
- Department of Pathology, Université de Montreal, Montreal, Quebec, Canada
| | - Evan Kalin-Hajdu
- Department of Ophthalmology, Université de Montreal, Montreal, Quebec, Canada
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12
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Lin S, Tong K, Wang G, Zhong Z, Cao S, Feng Z. Clinical characteristics and surgical treatment of haemophilic pseudotumor: A retrospective analysis of thirty-four patients. Haemophilia 2020; 26:873-881. [PMID: 32700372 DOI: 10.1111/hae.14109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
AIMS Haemophilic pseudotumor (HPT) is a rare but challenging complication of haemophilia. This study was intended to provide our experience about clinical characteristics and surgical treatment of HPT. METHODS Clinical medical records were retrieved from the Hemophilia Center, Nanfang Hospital, to identify the patients who had been surgically treated from 1 January 2006 to 31 December 2017 with a definite diagnosis of HPT. Their clinical features, surgical management, outcomes and complications after surgery were analysed. RESULTS We identified 34 patients with HPT who had surgical treatment over a 12-year period and five of them had multiple HPTs. The incidence of HPT at this centre was 2.3% over the dozen years. A previous trauma leading to the development of HPT was reported in 18 cases (52.9%). The HPT affected only soft tissue in 7 patients, bone and soft tissue in 25 ones and joint in 2 ones. Preoperative infection and fistula formation happened in ten patients, two of whom were related to abdominal HPTs. Enterococcus faecalis was cultured in five cases with fistula formation. HPT associated with pathological fracture was observed in five cases, two of whom were treated by external fixation and 3 by HPT resection and metallic internal fixation. Amputation was performed for nine patients, 6 of whom had preoperative infection and fistula formation. Their follow-up duration averaged 4.2 ± 2.9 years (range, from 1 to 13.5 years) after surgery. Of all our cases, three suffered from postoperative infection, five from recurrence of HPT and two with external fixation from fracture non-union. CONCLUSIONS HPT patients with preoperative infection had worse prognosis than those without. Surgical treatment plus intensive replacement therapy was effective for HPT but with a high rate of complications. HPT resection and metallic internal fixation rather than external fixation should be recommended for HPT patients with pathological fracture.
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Affiliation(s)
- Shiyuan Lin
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kai Tong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Orthopaedic Surgery, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Gang Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ziyi Zhong
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shenglu Cao
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zihang Feng
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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13
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Sharma A, Lodhi JS, Lingaiah P, Kumar A, Arora S. An Unusual Presentation of Hemophilia A: Pseudotumor of Distal End Radius-Masquerading as Giant Cell Tumor. J Hand Microsurg 2019; 11:S11-S15. [PMID: 31616120 DOI: 10.1055/s-0038-1646774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 04/02/2018] [Indexed: 10/14/2022] Open
Abstract
Hemophilia is a coagulation defect caused by a functional or absolute deficiency of coagulation factors. Deficiency of factor VIII leads to hemophilia A; deficiency of factor IX causes hemophilia B. Pseudotumor may arise from hemorrhage into the muscle and within the subperiosteal space and can lead to destruction of the adjacent muscle, bone, nerves, and vessels. A 60-year-old man presented with the complaint of pain and swelling in right wrist. The patient consulted the general practitioner who misdiagnosed it as a case of giant cell tumor due to typical X-ray changes. Biopsy was done following which there was prolonged bleeding leading to worsening of clinical condition and the patient presented in our hospital with ulcerated swelling. Routine blood investigations were within normal limit. Prothrombin time was 12.1 seconds and activated partial thromboplastin time (aPTT) was 54.3 seconds. Raised aPTT led to suspicion of hemophilia, and factor VIII and IX levels were investigated. Factor IX level was within normal limit. Factor VIII level was 6.3%. The patient was managed conservatively. Factor VIII level was replaced according to standard protocol (40 IU/kg per dose thrice a week for 10 days). Daily dressing was done using tranexamic acid locally. Lesion healed completely in 6 months.
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Affiliation(s)
- Amit Sharma
- Department of Orthopedics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India
| | - Jeetendra Singh Lodhi
- Department of Orthopedics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India
| | - Purushottam Lingaiah
- Department of Orthopedics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India
| | - Awkash Kumar
- Department of Orthopedics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India
| | - Sumit Arora
- Department of Orthopedics, Maulana Azad Medical College, Lok Nayak Hospital, New Delhi, India
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14
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Gavrel M, Rafowicz A, d'Oiron R, Franchi-Abella S, Lambert T, Adamsbaum C. Imaging features of atypical bleeds in young patients with hemophilia. Diagn Interv Imaging 2018; 100:135-145. [PMID: 30559038 DOI: 10.1016/j.diii.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical locations can be a diagnostic challenge, since clinicians and radiologists are often unfamiliar with their clinical and radiological features. Some atypical bleeds, however, can be life-threatening or severely disabling, highlighting the need for prompt, accurate diagnosis. Rare bleeds include central nervous system bleeds (including intracranial and spinal hematomas), urogenital bleeds, intra-abdominal bleeds (mesenteric and gastrointestinal wall hematomas) and pseudo tumors in unusual locations like the sinonasal cavities. Because clinical assessment can be difficult, clinicians and radiologists should be aware of the possibility of these rare complications in their hemophilia patients, so that they can avoid unnecessary invasive diagnostic and surgical procedures and institute prompt, appropriate treatment. The purpose of this review is to illustrate the imaging features of bleeds that occur in rare locations in young (i.e., children and young adults) patients with hemophilia to make the reader more familiar with these conditions.
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Affiliation(s)
- M Gavrel
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France.
| | - A Rafowicz
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - R d'Oiron
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - S Franchi-Abella
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - T Lambert
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - C Adamsbaum
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France; Faculty of Medicine, Paris-Sud University, 94270 Le Kremlin-Bicêtre, France
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Thomas BP, Fouzia NA, Raveendran S, Pallapati SR, Abraham A, Srivastava A. Management of Hemophilic Cysts and Pseudotumors of the Hand in Bleeding Disorders: A Case Series. J Hand Surg Am 2018; 43:486.e1-486.e9. [PMID: 29268963 DOI: 10.1016/j.jhsa.2017.10.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 10/03/2017] [Accepted: 10/31/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Hemophilic cysts and pseudotumors (HCPTs) of the hand are rare and are secondary to bleeding disorders such as hemophilia A and B. This is a report of our experience in the management of this rare condition. PATIENTS AND METHODS Seven male patients with hemophilia A presenting with progressive swelling of the hand were treated between 2004 and 2013 at a tertiary referral hospital. All patients had clotting factor replacement based on our previously reported protocol. The age of the patients ranged from 3 to 49 years (median age, 19 years). RESULTS Four patients had soft tissue hemophilic cysts and 3 had bony hemophilic pseudotumors. Two patients had traumatic pseudoaneurysm of the ulnar artery in addition to the cysts. The soft tissue cysts required surgical excision in 3 patients under factor cover as per the protocol. The bony lesions were initially managed nonsurgically by factor replacement, but 2 patients failed to respond and required amputation of the fingers. The ulnar artery aneurysm was excised and artery ligated in 1 patient and the artery was vein grafted owing to poor hand perfusion in 1. CONCLUSIONS Based on our observations in the management of HCPTs of the hand and the existing literature, we conclude that the soft tissue cysts require surgical excision along with factor replacement and distal bony lesions smaller than 3 cm respond to factor replacement. Larger bony lesions require surgical treatment. Treatment of hemophilic cysts and pseudotumors should be undertaken only in centers with a major hematology backup. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic V.
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Affiliation(s)
- Binu Prathap Thomas
- Paul Brand Centre for Hand Surgery & Peripheral Nerve Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India.
| | - N A Fouzia
- Department of Hematology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Sreekanth Raveendran
- Paul Brand Centre for Hand Surgery & Peripheral Nerve Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Samuel R Pallapati
- Paul Brand Centre for Hand Surgery & Peripheral Nerve Surgery, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Aby Abraham
- Department of Hematology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Alok Srivastava
- Department of Hematology, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
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Bone haemophilic pseudotumour of the ulna: A rare complication of haemophilia in a dog. Vet Comp Orthop Traumatol 2017; 30:371-376. [PMID: 28763522 DOI: 10.3415/vcot-17-01-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/12/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This case report describes for the first time a bone haemophilic pseudotumour in a dog. CASE DESCRIPTION A seven-month-old German Shepherd male dog was presented with the complaint of a forelimb weight-bearing lameness with major swelling that expanded dramatically after fine needle aspiration. Radiographs showed a large, well-defined ulnar diaphyseal cystic-like osteolytic lesion. Based on prolonged activated partial thromboplastin time (aPTT) and low factor VIII activity, haemophilia A was diagnosed. Bone scintigraphy, computed tomography, magnetic resonance imaging, and histological findings definitely ruled out malignant neoplasia or inflammation and strongly supported a bone haemophilic pseudotumour over an aneurysmal bone cyst. Segmental ulnar resection and replacement by a polymethylmethacrylate spacer combined with perioperative bleeding management resulted in a successful outcome. DISCUSSION This case provided evidence that a bone haemophilic pseudotumour may be the sole presenting clinical sign of haemophilia A in dogs. Early diagnosis, based on history and magnetic resonance imaging findings, is imperative for prompt treatment leading to successful outcome. It is challenging as fine needle aspiration or biopsy is contraindicated. As described in humans, surgical excision of the lesion combined with management of severe postoperative bleeding was associated with successful outcome in the present case. CLINICAL SIGNIFICANCE A bone haemophilic pseudotumour should be considered in the differential diagnosis of expanding mass associated with osteolysis, especially in young male dogs. Perioperative monitoring of the bleeding disorder and subsequent FVIII replacement therapy was of paramount importance in the present case.
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Zhai J, Weng X, Zhang B, Liu Y, Gao P, Bian YY. Surgical Treatment for Hemophilic Pseudotumor: Twenty-three Cases with an Average Follow-up of 5 Years. J Bone Joint Surg Am 2017; 99:947-953. [PMID: 28590380 DOI: 10.2106/jbjs.16.01299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Hemophilic pseudotumor (HPT) is a rare disease with many challenges. Only a few reports on surgical treatment for HPT have been published. METHODS The cases of 23 patients with HPT who had surgical treatment from July 1996 to December 2014 were retrospectively reviewed. Demographic data, blood loss and transfusion during surgery, outcomes, and complications after surgery were analyzed. RESULTS Eleven patients underwent HPT resection; 4 underwent HPT excision, allograft transplantation, and absorbable screw fixation; 3 had HPT resection and metallic internal fixation; 2 had HPT resection, autogenous fibular grafting, and absorbable screw fixation; 2 underwent curettage and bone-grafting; and 1 patient received above-the-knee amputation. The average age (and standard deviation) of the patients at the time of surgery was 31.9 ± 12.8 years (range, 6 to 54 years) with an average follow-up of 5.3 ± 4.7 years (range, 1.1 to 19.6 years). The median duration of the surgery was 157 minutes (range, 90 to 315 minutes). The median amount of blood loss during surgery was 800 mL (range, 100 to 4,000 mL). Three patients (13%) had a postoperative infection, 2 (8.7%) had recurrence of HPT, and another 2 patients had fracture nonunion. CONCLUSIONS Surgical treatment of HPT with a modified protocol of coagulation factor replacement is safe and effective. It should be recommended for patients with HPT who have progressive enlargement of the mass, recurrent and massive bleeding, spontaneous perforation, bone erosion, or compression of surrounding tissues or who have had failure of conservative treatment. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jiliang Zhai
- 1Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Duarte ML, Duarte ÉR, Solorzano EB. Hemophilic pseudotumor - a rare complication. Rev Bras Hematol Hemoter 2017; 39:84-85. [PMID: 28270356 PMCID: PMC5339361 DOI: 10.1016/j.bjhh.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 10/15/2016] [Accepted: 10/20/2016] [Indexed: 10/26/2022] Open
Affiliation(s)
- Márcio Luís Duarte
- Clinica Radiológica e Especialidades Médicas São Gabriel, Praia Grande, SP, Brazil; WebImagem, São Paulo, SP, Brazil.
| | - Élcio Roberto Duarte
- Clinica Radiológica e Especialidades Médicas São Gabriel, Praia Grande, SP, Brazil; Brasil Imagem Medicina Diagnóstica, Santos, SP, Brazil
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Hemophilic pseudotumor in a non-hemophilic patient treated with a hybrid procedure of preoperative embolization of the feeding arteries followed by surgical resection-A case report. Int J Surg Case Rep 2016; 27:165-168. [PMID: 27615056 PMCID: PMC5021780 DOI: 10.1016/j.ijscr.2016.08.032] [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: 05/21/2016] [Revised: 08/14/2016] [Accepted: 08/20/2016] [Indexed: 11/22/2022] Open
Abstract
Hemophilic pseudotumor is a rare complication of Hemophilia A and B. Diagnosis requires a high index of suspicion-especially in non-hemophilic patients. Radiographic findings are similar to that of malignant tumors. Surgical intervention remains the mainstay of treatment. Pre-operative embolization has been shown to reduce intra-operative bleeding.
Introduction Hemophilic pseudotumor is a rare but well documented complication seen in approximately 1–2% of patients with hemophilia. The incidence continues to decrease, likely because of increasingly sophisticated techniques in managing factor deficiency. We present a case of hemophilic pseudotumor in a patient without hemophilia, an exceptionally rare entity, and outline a hybrid approach to treatment. Presentation of case The patient presented with a left sided iliopsoas mass and associated radiculopathy, with a history of a poorly characterized bleeding diathesis and Noonan’s syndrome. He had no history of trauma and was not being treated with anti-coagulation. Of note, factors VIII, IX and XI were normal. An open biopsy was consistent with hemophilic pseudotumor. The patient underwent a hybrid procedure of preoperative embolization of the left internal iliac and left deep circumflex arteries followed by surgical debridement and resection, with an excellent outcome. Discussion Hemophilic pseudotumor is rarely seen in patients with hemophilia, and even less frequently in patients without. Trauma is often the inciting event. A high index of clinical suspicion is required in order to secure the diagnosis, as the radiographic appearance is non-specific. Our patient had no history of trauma, although we question whether his underlying bleeding diathesis may have predisposed him to developing the pseudotumor. Surgery remains the cornerstone of management in these cases. Conclusion Within the literature, there are only two other cases of hemophilic pseudotumor occurring in a non-hemophiliac patient, highlighting the rarity of this case and the associated diagnostic dilemma.
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Sagheer S, Atkins A, McRae S. Successful use of tranexamic acid in the management of haemophilic pseudotumour. Haemophilia 2016; 22:e306-9. [PMID: 27291716 DOI: 10.1111/hae.12911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- S Sagheer
- Haematology Division, SA Pathology, Adelaide, SA, Australia
| | - A Atkins
- Haematology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - S McRae
- Haematology Division, SA Pathology, Adelaide, SA, Australia.,Haematology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
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Li Y, Weng XS, Lin J, Jin J, Qian WW, Zhang BZ, Gao P, Zhai JL. Perioperative Period of a Hemophilia-related Osteoarthropathy Therapeutic Regimen and Analysis of Complications. Orthop Surg 2016; 8:60-7. [PMID: 27028382 DOI: 10.1111/os.12222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/28/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate the effectiveness of our department's therapeutic regimen and treatment of complications during the perioperative period of hemophilia-related osteoarthropathy. METHODS In this retrospective study, data on 101 patients with hemophilia who had undergone operative treatment in our hospital from January 2000 to August 2014 were assessed. Ninety-one of the patients had hemophilia A and 10 hemophilia B. All patients were male. Changes in Hospital for Special Surgery (HSS), Harris and American Orthopedic Foot and Ankle Society (AOFAS) scores, occurrence of complications during the perioperative period and the clinical treatment and prognosis pre- and postoperatively and during follow-up were analyzed. Relevant clinical data were obtained through telephone calls, outpatient follow-up, and medical clinical record searches. RESULTS The 101 patients who were followed up (for an average of 96 months) had 147 orthopedic operations, including joint replacement, hemophilia-related false tumor resections, and tendo-achillis lengthening. The HSS scores for knee surgeries increased from 52 points preoperatively to 86 postoperatively, Harris scores for hip joint surgery from 26 to 87 points, respectively, and AOFAS scores for foot and ankle surgeries from 39 to 81 points, respectively. Eight patients had wound complications, four intra-articular hematomas, two peroneal nerve injuries, one a proximal femur splitting fracture and one deep venous thrombosis. CONCLUSIONS Surgical treatment is a safe and reliable choice for addressing complications including hemophilia-related osteoarthropathy given the implementation of effective measures for treatment during the perioperative period.
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Affiliation(s)
- Ye Li
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xi-sheng Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Lin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jin Jin
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-wei Qian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Bao-zhong Zhang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Peng Gao
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Ji-liang Zhai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Zhai J, Weng X, Zhang B, Peng HM, Bian YY, Zhou L. Surgical management of hemophilic pseudotumor complicated by destructive osteoarthropathy. Blood Coagul Fibrinolysis 2015; 26:373-7. [PMID: 25629563 PMCID: PMC4888934 DOI: 10.1097/mbc.0000000000000260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 09/07/2014] [Accepted: 11/26/2014] [Indexed: 12/02/2022]
Abstract
Hemophilic pseudotumor gradually erodes bone and induces fracture or deformity, causing joint dysfunction or destructive osteoarthropathy. Reports about surgery for hemophilic pseudotumor complicated by destructive osteoarthropathy are scarce. The object of this study was to evaluate the results and complications of surgical management for patients of pseudotumor complicated by destructive osteoarthropathy. We retrospectively reviewed records from July 1996 to July 2013, and found eight patients with pseudotumor complicated by destructive osteoarthropathy. We recorded their demographic data, time of surgery, amount of blood loss and transfusion, bone union, and complications. Seven patients were diagnosed with hemophilia A and one with hemophilia B. The mean age at surgery was 31.9 ± 8.3 years. Two of the eight underwent excision of the pseudotumor and metallic fixation, one had amputation, and five underwent autogenous or exogenous bone grafting and fixation with an absorbable screw. The median operating time was 170 min (135-315 min). The median amount of intraoperative blood loss was 1350 ml (100-4000 ml). The amount of red blood cells, plasma, and whole blood transfusion after surgery were 0-24 units, 0-2000 ml, and 0-4600 ml, respectively. After a median follow-up of 75 months, the numbers of pseudotumor recurrence, fracture nonunion, coagulation factor inhibitor formation, and wound complications were one, one, two, and four, respectively. Surgery is an effective treatment for hemophilic pseudotumor complicated by destructive osteoarthropathy. However, the incidences of wound infection, coagulation factor inhibitor formation, hemophilic pseudotumor recurrence, and fracture nonunion are high.
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Affiliation(s)
- Jiliang Zhai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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A pelvic pseudotumor in a nonhemophilic patient: an unusual presentation. Case Rep Hematol 2015; 2015:359735. [PMID: 26000180 PMCID: PMC4427095 DOI: 10.1155/2015/359735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/11/2015] [Accepted: 04/15/2015] [Indexed: 11/18/2022] Open
Abstract
Hemophilic pseudotumor is a rare complication of hemophilia, occurring in 1 to 2 percent of individuals with severe factor VIII or factor IX deficiency. A 35-year-old male presented with a
swelling in the right lower abdomen for 3 months. There was no history of trauma. Examination revealed a swelling over the right iliac fossa. Right hip showed 30° flexion deformity. Blood investigations like complete blood count, APTT, PT, bleeding and clotting time, and fibrinogen were all normal. Plain radiograph and MRI showed a lytic lesion in the right iliac wing. Excision biopsy of the swelling showed organized hematoma with a fibrous capsule suggestive of a pseudotumor. Further haematological workup like factors VIII and IX was normal. At 2 years follow-up, there was no recurrence. We report this case of pseudotumour in patient without any bleeding disorder. Such case has not been reported in literature to the best of our knowledge.
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Abstract
Hemophilic pseudotumor is a rare complication of hemophilia. We present the case of a male toddler with moderate hemophilia A and cranial hemophilic pseudotumor managed with factor VIII infusions. We also provide a review of the literature. Recognition of this rare manifestation of this complication of hemophilia is important to provide correct treatment and avoid unnecessary investigations, particularly biopsy, which is contraindicated in this condition.
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Ozcan HN, Ergen FB, Aydingoz U. Intraosseous pseudotumor in a child with hypofibrinogenemia. Pediatr Radiol 2014; 44:1458-61. [PMID: 24801817 DOI: 10.1007/s00247-014-3004-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/09/2014] [Accepted: 04/09/2014] [Indexed: 11/26/2022]
Abstract
Intraosseous pseudotumor (i.e. chronic, encapsulated, hemorrhagic fluid collection that can be seen in any portion of the tubular bones) is an uncommon complication of severe hemophilia; however, it can occur with other rare bleeding disorders. We present the case of an 11-year-old girl with hypofibrinogenemia who had multiple intramedullary lesions that were consistent with intramedullary pseudotumor associated with this rare bleeding disorder. Percutaneous biopsy of a pseudotumor is contraindicated due to the high prevalence of complications, including life-threatening bleeding. Therefore, radiologists should make the diagnosis with characteristic MR imaging findings in a patient with a severe coagulation disorder.
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Affiliation(s)
- H Nursun Ozcan
- Department of Pediatric Radiology, Hacettepe University Medical School, Fakülteler Mah. Dirim sok 22/3, Cebeci, 06590, Ankara, Turkey,
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López-Gómez J, Contreras JS, Figueroa-Ruiz M, Servín-Torres E, Velázquez-García J, Bevia-Pérez F, Delgadillo-Teyer G. Management of the hemophilic pseudotumor of the abdomen: A rare pathological entity. Int J Surg Case Rep 2014; 5:789-92. [PMID: 25290383 PMCID: PMC4245669 DOI: 10.1016/j.ijscr.2014.08.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 07/16/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Hemophilic pseudotumor is a rare complication that occurs in patients with severe hemophilia. Results from multiple episodes of bleeding into the bones and soft tissues. PRESENTATION OF CASE A 31 years old male patient, with severe hemophilia A. Diagnosed with an abdominal tumor 10 years ago during routine screening, that progressively grew to encompass the entire abdominal area, with symptoms of intestinal obstruction. DISCUSSION Hemophilic pseudotumor appears as a painless tumor of slow growth that can compress vital organs producing bone destruction, muscle and skin necrosis. The tumor may have fistulas or break spontaneously. CONCLUSION The abdominal hemophilic pseudotumor is a rare pathological entity, with few reports worldwide, but must be considered in hemophilic patients with a well documented abdominal tumor.
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Affiliation(s)
- Javier López-Gómez
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico.
| | - Juan S Contreras
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Marco Figueroa-Ruiz
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Erick Servín-Torres
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - José Velázquez-García
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Francisco Bevia-Pérez
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Germán Delgadillo-Teyer
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
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Low SF, Sridharan R, Ngiu CS, Haflah NHM. Osseous haemophilic pseudotumour and concurrent primary hyperparathyroidism: a diagnostic conundrum. BMJ Case Rep 2014; 2014:bcr-2013-203282. [PMID: 24729114 DOI: 10.1136/bcr-2013-203282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pseudotumours are rare, occurring in 1-2% of severe haemophiliacs. Osseous locations are far less frequent than soft tissue location. We report a case of a 43-year-old man with haemophilia A, who presented with a gradually enlarging left thigh mass for 8 months. There were no constitutional symptoms. Plain radiograph showed an expansile lytic lesion with 'soap-bubble' appearance arising from the left femur diaphysis. On MRI, it appeared as a non-enhancing, multilobulated lesion expanding the medullary and subperiosteal spaces. The mass exhibited concentric ring sign with heterogeneous intermediate signal intensity in the core lesion, reflective of chronic haematoma with blood degradation products of different stages. A diagnosis of haemophilic pseudotumour was made. Hypercalcaemia, however, raised a diagnostic dilemma as bone malignancy needed to be considered. An open excisional biopsy and subsequent amputation confirmed the diagnosis of osseous haemophilic pseudotumour. Nuclear medicine study later revealed a concurrent parathyroid adenoma.
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Affiliation(s)
- Soo Fin Low
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Purkait R, Mukherjee A, Naskar S, Bhadra R. Nasal hemophilic pseudotumor: favorable response to radiotherapy. Indian Pediatr 2013; 50:334-5. [PMID: 23680608 DOI: 10.1007/s13312-013-0071-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hemophilic pseudotumors are rare but dangerous complications of Hemophilia. We hereby report a 3-year-old boy with Hemophilia B, presenting with nasal pseudotumor, showing favorable response to radiotherapy after unsuccessful treatment with factor IX replacement therapy. The diagnosis and treatment of this rare condition is also reviewed.
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Affiliation(s)
- Radheshyam Purkait
- Department of Paediatric Medicine, NRS Medical College and Hospital, 138, AJC Bose Road, Kolkata, West Bengal, India.
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Yang BT, Wang YZ, Wang XY, Wang ZC. Imaging features of paediatric haemophilic pseudotumour of the maxillary bone: report of three cases and review of the literature. Br J Radiol 2012; 85:1107-11. [PMID: 22253339 DOI: 10.1259/bjr/12938443] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Haemophilic pseudotumour (HP) is an extremely rare lesion. The purpose of this study was to describe the CT and MRI features of maxillary bone HPs and introduce the key points to differentiate HP from the mimicking entities in the region. METHODS We retrospectively reviewed three paediatric patients with histology-proven HPs arising from the maxillary bone. All three patients underwent CT and/or MRI. Combined with six previously reported cases in the literature, the imaging features were comprehensively analysed. RESULTS All HPs showed a well-demarcated, multilobulated expansile osteolytic lesion in the maxillary bone. On non-enhanced CT, HPs appeared of mixed density relative to grey matter. The lesions appeared to have markedly heterogeneous signal intensity on both T(1) and T(2) weighted images, with septa-like enhancement following the administration of contrast material, which corresponded to blood products in various stages of evolution. The lesions caused cortical thinning and even focal disappearance and multiple bone septa were identified within the involved maxillary bone. Some HPs were associated with radiated periosteal proliferation, which can easily be misdiagnosed as a malignant bone tumour. CONCLUSION A high index of suspicion for HP and a familiarity with imaging findings may help to accurately diagnose this rare entity.
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Affiliation(s)
- B T Yang
- Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China. cjr.yangbentao@vip163. com
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Jaganathan S, Gamanagatti S, Goyal A. Musculoskeletal Manifestations of Hemophilia: Imaging Features. Curr Probl Diagn Radiol 2011; 40:191-7. [DOI: 10.1067/j.cpradiol.2010.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Feng Xue, Chaoxia Sun, Tao Sui, Lei Zhang, Lihui Jiang, Renchi Yang. Hemophilic Pseudotumor in Chinese Patients: A Retrospective Single-Centered Analysis of 14 Cases. Clin Appl Thromb Hemost 2010; 17:279-82. [PMID: 20460342 DOI: 10.1177/1076029610366433] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pseudotumor is an uncommon but severe complication in patients with hemophilia. To our knowledge, although China has large population of persons with hemophilia, there is rare information on the incidence, clinical feature, image finding, and management of pseudotumor among Chinese patients. This study aimed at improving our knowledge on clinical diagnosis and management of hemophiliac pseudotumor. In this retrospective study, the medical records of 1248 patients with hemophilia diagnosed between January 1983 and October 2004 at our hospital were reviewed. The clinical feature, imaging finding, management, and outcome of 14 patients with pseudotumor among these patients with hemophilia were analyzed. All patients have hemophilia A (8 severe cases and 6 moderate cases). Eight patients sustained an injury prior to the development of pseudotumor. Main image findings included osteolysis lesion, soft tissue swelling, or lump. Surgical therapy was carried out in 7 patients and 6 achieved remission, with fistula formation remaining in 1. One patient underwent radiotherapy together with replacement therapy achieved remission. Three patients accepted replacement therapy as only management and only 1 patient achieved improvement of swelling. Our study showed that the incidence of pseudotumor in our enrolled patients with hemophilia is 1.12%. Hemophilic history of patients can contribute to the right diagnosis of pseudotumor. Surgical therapy together with sufficient replacement therapy is safe and effective.
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Affiliation(s)
- Feng Xue
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Chaoxia Sun
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Tao Sui
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Lei Zhang
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Lihui Jiang
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
| | - Renchi Yang
- Department of Thrombosis and Hemostasis, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin China
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Kilic YA, Dundar SV, Onat D, Akhan O. Iliopsoas hemophilic pseudotumor with bowel fistulization. ACTA ACUST UNITED AC 2010. [PMID: 20120446 DOI: 10.4236/ijcm.2012.33046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Haemophiliac pseudotumors are usually observed in the diaphysis of long bones. Pseudotumors due to psoas muscle hematoma are rare and surgical management is difficult. Surgical treatment of these lesions is usually associated with high morbidity and mortality rate. Here, we present a case with iliopsoas haemophiliac pseudotumors with bowel fistulization who underwent three abdominal operations and survived. Based on our experiences in this patient, we recommend to wait for the intraabdominal hematoma and adhesions to resolve and organise, so that the dissection can be kept to a minimum, which decreases the chances of iatrogenic injury and surgical bleeding (Fig. 3, Ref. 15). Full Text (Free, PDF) www.bmj.sk.
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Affiliation(s)
- Yusuf Alper Kilic
- Department of General Surgery, Hacettepe University, Ankara, Turkey.
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Abstract
We report a case of a large pseudotumour in the right talus of an 11-year-old boy with severe haemophilia A. The described intraosseous lesion was treated with surgical curettage and autologous bone grafting. Twenty months postoperatively computed tomography scan showed no signs of recurrence. Forty months postoperatively radiological studies confirmed satisfactory incorporation of the graft, no evidence of bone growth disturbance and improvement of Pettersson score of the ankle joint. At the same time, regarding his clinical situation, he was able to fully participate in his daily activities, presenting painless and almost full range of motion of his right ankle joint. Surgical intervention seems to be the best option in treating a big pseudotumour of the talus during childhood. As conservative management in the treatment of large lesions may fail, disastrous complications like a pathological fracture may happen. Anatomical reconstruction of a talus when pseudotumour and pathological fracture coexist is a major challenge for an orthopaedic surgeon.
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34
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Dixon TL, Kransdorf MJ, Krishna M, O’Connor MI. Thigh pain in a 73-year-old man. Clin Orthop Relat Res 2009; 467:3040-5. [PMID: 19184261 PMCID: PMC2758964 DOI: 10.1007/s11999-009-0710-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Accepted: 01/08/2009] [Indexed: 02/09/2023]
Affiliation(s)
- Tonya L. Dixon
- Meharry Medical College School of Medicine, Nashville, TN USA
| | | | - Murli Krishna
- Department of Pathology, Mayo Clinic, Jacksonville, FL USA
| | - Mary I. O’Connor
- Department of Orthopedic Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
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35
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Maclachlan J, Gough-Palmer A, Hargunani R, Farrant J, Holloway B. Haemophilia imaging: a review. Skeletal Radiol 2009; 38:949-57. [PMID: 18807029 DOI: 10.1007/s00256-008-0586-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 08/16/2008] [Accepted: 08/18/2008] [Indexed: 02/02/2023]
Abstract
Haemophilia disorders are characterised by a blood coagulation anomaly leading to prolonged and excessive bleeding. Imaging provides an essential role in the investigation of both the musculoskeletal and the non-musculoskeletal complications of haemophilia. Our institution is home to a large tertiary referral centre for haemophilia treatment. Using our broad experience, we present a multi-modality pictorial review of the musculoskeletal manifestations of haemophilia, including haemophilic arthropathy, intra-muscular haemorrhage and haemophilic pseudotumour. The main imaging features of haemophilic arthropathy are described, including synovial hypertrophy, haemosiderin deposition, sub-chondral cyst formation and loss of joint space.
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36
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Santos MK, Polezi MB, Engel EE, Pastorello MT, Simão MN, Elias Junior J, Nogueira-Barbosa MH. Apresentações incomuns no diagnóstico por imagem do pseudotumor intraósseo do hemofílico. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000300008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Este estudo tem como objetivo descrever apresentações incomuns do pseudotumor do hemofílico no diagnóstico por imagem. MATERIAIS E MÉTODOS: Estudo retrospectivo com avaliação de cinco pseudotumores ósseos do hemofílico em dois pacientes. Os achados de imagem em dois pacientes hemofílicos tipo A foram avaliados em consenso por dois radiologistas musculoesqueléticos. Foram estudados exames de radiografia simples, tomografia computadorizada e ressonância magnética. RESULTADOS: Em uma das lesões analisadas a fase pós-contraste intravenoso da tomografia computadorizada mostrou áreas de reforço heterogêneo e de aspecto sólido no interior da lesão da coxa direita. Este aspecto foi confirmado no exame anatomopatológico da lesão em questão. Outro achado raro foi a identificação de dois pseudotumores intraósseos no úmero, separados por segmento de osso normal. E, por fim, também um pseudotumor do fêmur com extensão para partes moles e transarticular, com conseqüente acometimento da tíbia e patela. CONCLUSÃO: Os achados de diagnóstico por imagem acima descritos não são comumente relatados para os pseudotumores ósseos do hemofílico. É importante que o radiologista tenha conhecimento dessas apresentações mais raras.
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37
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Constantine S, Buckley J, Heysen J. Imaging of the haemorrhagic complications of the haemophilias. J Med Imaging Radiat Oncol 2009; 53:13-21. [DOI: 10.1111/j.1754-9485.2009.02032.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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38
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Abstract
Hemophilic pseudotumors are rare, but well known complications of severe hemophilia A, which most frequently develops at the femur, tibia, pelvic bones, iliac bones, or rarely in the cranium or gnathic bones. This report describes a case of hemophilic pseudotumor of the maxillary alveolar ridge that occurred in a boy with mild hemophilia A (14% factor VIII activity). The lesion, which presented as an alveolar mucosal swelling, responded well to enucleation, curettage, and intralesional fibrin glue injection.
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39
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Nongrum B, Srinivasan R, Pandian DG, Gupta A, Krishnan M. Role of radiotherapy in hemophilic pseudotumor of the orbit. Orbit 2008; 27:377-379. [PMID: 18836937 DOI: 10.1080/01676830802317348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Hemophilic pseudotumor is an encapsulated, chronic, slowly expanding hematoma usually seen in 1-2% patients with severe coagulative disorder (James et al., 2003). It usually occurs in soft tissues, muscles, tendons, and subperiosteal part of the bones. It slowly enlarges, develops a fibrous capsule, and destroys underlying tissues by progressive necrosis (James et al., 2003). Hemophilia is an X chromosome-linked hereditary disorder caused by defective synthesis or synthesis of dysfunctional factor VIII molecules (Harold et al., 2006).
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Affiliation(s)
- Benjamin Nongrum
- Jawaharlal Institute of Post-Graduate Medical and Educational Research, Pondicherry, India.
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Castro-Boix S, Pradell-Teigell J, Boqué-Genovard R, Zanón-Navarro V, Nadal-Guinard A, Altisent-Roca C, Armengol-Carrasco M. [Hemophilic pelvic pseudotumor]. Cir Esp 2007; 81:102-4. [PMID: 17306128 DOI: 10.1016/s0009-739x(07)71273-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Surgery in hemophilic patients is a challenge for the general surgeon. Hemophilic pseudotumor is a rare complication occurring in 1-2% of hemophiliacs and affecting mainly patients with severe disease or those who have developed antibodies to factor VIII or IX. A number of alternatives are available for the management of these tumors, including conservative treatment, surgical removal, percutaneous drainage, embolization, and external radiation. The only definitive treatment is surgical excision. We report a case of hemophilic pseudotumor of the pelvic bone. Treatment consisted of surgical resection after arterial embolization using factor replacement to achieve hemostasis.
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Affiliation(s)
- Sandra Castro-Boix
- Servicio de Cirugía General, Unidad de Cirugía Esofagogástrica, Hospital Vall d'Hebron, Barcelona, España.
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41
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O'Dowd M, Geoghegan T, Munk PL, McAuley G, Torreggiani WC. Haemophilic pseudotumour presenting with large bowel obstruction. AUSTRALASIAN RADIOLOGY 2006; 50:386-8. [PMID: 16884430 DOI: 10.1111/j.1440-1673.2006.01607.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Osseous haemophilic pseudotumours are uncommon. The commonest sites of involvement are the femur and the pelvis. Trauma is the initiating factor in most reported cases and repeated bleeding into the lesion contributes to their growth. Most lesions grow slowly and are often asymptomatic. Complications include massive haemorrhage, infection and pathological fracture. We present an extremely unusual presentation where a large haemophilic pseudotumour of the pelvis extended to impinge the adjacent colon, resulting in large bowel obstruction.
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Affiliation(s)
- M O'Dowd
- Department of Radiology, The Adelaide and Meath Hospital, Dublin, Ireland
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Niimi R, Matsumine A, Kusuzaki K, Okamura A, Matsubara T, Uchida A, Fukutome K. Soft-tissue sarcoma mimicking large haematoma: a report of two cases and review of the literature. J Orthop Surg (Hong Kong) 2006; 14:90-5. [PMID: 16598096 DOI: 10.1177/230949900601400120] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report on 2 patients with soft-tissue sarcomas mimicking large haematomas. Neither patient had a medical history of trauma or bleeding tendency. In a patient with a large leiomyosarcoma in the buttock, insufficient biopsy material from initial surgeries precluded a correct diagnosis. In the second patient with epithelioid sarcoma of the forearm, fasciotomy was repeatedly performed for compartment syndrome arising from the tumour. It is important to reconfirm prior trauma and investigate the clinical course and images of patients with an unusual history of haematoma in the extremities. The possibility of a malignant tumour should be suspected, and repeated biopsies should be performed if necessary.
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Affiliation(s)
- R Niimi
- Department of Orthopaedic Surgery, Mie University Faculty of Medicine, Mie, Japan
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43
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Park JS, Ryu KN. Hemophilic Pseudotumor Involving the Musculoskeletal System: Spectrum of Radiologic Findings. AJR Am J Roentgenol 2004; 183:55-61. [PMID: 15208110 DOI: 10.2214/ajr.183.1.1830055] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Ji Seon Park
- Department of Diagnostic Radiology, Kyung Hee University Hospital, Heokidong Dongdaemun-ku, Seoul 130-702, South Korea
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