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Telangiectatic soft tissue sarcoma and chronic expanding haematoma: a comparative review of MRI features. Skeletal Radiol 2021; 50:2365-2380. [PMID: 34184096 DOI: 10.1007/s00256-021-03853-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 02/02/2023]
Abstract
Soft tissue sarcomas containing a dominant component of haemorrhage are known to be aggressive tumours associated with a poor prognosis. Importantly, the clinical behaviour and imaging characteristics of extensively haemorrhagic soft tissue sarcomas (also termed telangiectatic soft tissue sarcomas) can resemble those of benign haematomas, particularly those that continue to expand over a prolonged period, so-called chronic expanding haematomas (CEH). The following review evaluates the current literature to identify the clinical, imaging and pathological characteristics of telangiectatic soft tissue sarcomas and to determine features that may help distinguish them from CEH. Ultimately, we suggest that lesions with sizeable regions of internal haemorrhage should be regarded with a high degree of suspicion for underlying malignancy and require referral to a tertiary sarcoma centre, where a carefully planned approach to biopsy and follow-up is needed to avoid errors in diagnosis.
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Hill AG. Expanding haematoma in a lace monitor (
Varanus varius
). VETERINARY RECORD CASE REPORTS 2021. [DOI: 10.1002/vrc2.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kajioka H, Morito T, Kokudo Y, Muraoka A. Effectiveness of gallium scintigraphy in diagnosing a spontaneous giant chronic expanding hematoma of the adrenal gland: A case report. Int J Surg Case Rep 2020; 76:270-273. [PMID: 33053488 PMCID: PMC7566197 DOI: 10.1016/j.ijscr.2020.09.199] [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] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022] Open
Abstract
A chronic expanding hematoma of the adrenal gland is extremely rare. Chronic expanding hematomas mimic sarcomatous lesions. Gallium scintigraphy may help the differential diagnosis between chronic expanding hematomas and sarcomatous lesions. Complete resection of chronic expanding hematomas is the gold standard. Preoperative arterial embolization may reduce intraoperative bleeding on complete tumor removal.
Introduction A chronic expanding hematoma in the retroperitoneal space is a rare disease with poorly understood pathology, and preoperative diagnosis of such hematomas using conventional methods is sometimes difficult. Presentation of case A 68-year-old man with a history of slowly progressive abdominal distention was referred to our department for further evaluation. Contrast-enhanced CT revealed a large retroperitoneal tumor of the adrenal gland. MRI revealed that the tumor was iso-intense to hyperintense on T2-weighted imaging, with heterogeneous signal intensity on T1-weighted imaging without fat components. Angiography of the left adrenal artery confirmed many extravasations into the tumor. However, gallium scintigraphy showed no accumulation in the tumor. These findings were suggestive of a chronic expanding hematoma of left adrenal gland. This patient underwent complete tumor resection. Postoperative histopathological findings revealed a chronic expanding hematoma. Discussion Chronic expanding hematomas are slowly expanding, space-occupying masses as a result of trauma, surgery, or bleeding disorders. Chronic expanding hematomas mimic malignant tumors such as sarcomatous lesions. Although CT and MRI are used to obtain the diagnosis, the diagnosis is sometimes difficult. Gallium scintigraphs play a pivotal role in the differential diagnosis between them. Conclusion Gallium scintigraphs, magnetic resonance imaging and computed tomography, are useful tools to differentiate chronic expanding hematomas from sarcomatous lesions.
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Affiliation(s)
- Hiroki Kajioka
- Department of Surgery, Kagawa Rosai Hospital, 3-3-1 Zyoto-cho, Marugame-shi, Kagawa, 763-8502, Japan.
| | - Toshiaki Morito
- Department of Pathology, Kagawa Rosai Hospital, 3-3-1 Zyoto-cho, Marugame-shi, Kagawa, 763-8502, Japan.
| | - Yasutaka Kokudo
- Department of Surgery, Kagawa Rosai Hospital, 3-3-1 Zyoto-cho, Marugame-shi, Kagawa, 763-8502, Japan.
| | - Atsushi Muraoka
- Department of Surgery, Kagawa Rosai Hospital, 3-3-1 Zyoto-cho, Marugame-shi, Kagawa, 763-8502, Japan.
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Raja A, Ahmad S, Ehmed S, Blume T, Fai EK, Khan AS. Chronic Expanding Hematoma in the Dorsal Cervicothoracic Region as a Long-Term Complication of Retained Bullet Fragments: Case Report. Cureus 2016; 8:e858. [PMID: 27917326 PMCID: PMC5133135 DOI: 10.7759/cureus.858] [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] [Indexed: 11/06/2022] Open
Abstract
Chronic expanding hematoma is a rare pathology, which has not been previously described as a complication of gunshot injury with retained bullet fragments. Because of the similar characteristics of chronic expanding hematoma to malignancy, it can present a diagnostic challenge for clinicians. Imaging and biopsy evaluation is needed to reach a conclusive diagnosis and implement appropriate treatment. In this case report, we will discuss the development, diagnosis, and management of a chronic superficial cervicothoracic mass in a patient who presented 30 years post-gunshot injury with retained bullet fragments.
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Affiliation(s)
- Avais Raja
- Department of Orthopaedic Surgery, Shifa College of Medicine, Islamabad, Pakistan
| | | | - Salman Ehmed
- Emergency Medicine, Kings Edward Medical University
| | - Terri Blume
- Neurosurgery, University of Maryland Medical Center Midtown Campus
| | - Emmanuel K Fai
- Neurosurgery, University of Maryland Medical Center Midtown Campus
| | - Agha S Khan
- Neurosurgery, University of Maryland Medical Center Midtown Campus
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Encapsulated lumbar hematoma after fall from standing height. Spine J 2015; 15:e11. [PMID: 26193684 DOI: 10.1016/j.spinee.2015.07.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 07/07/2015] [Indexed: 02/03/2023]
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Sebbag L, Harkin KR, Habekost A, Gumber S, Lee T. Abdominal Chronic Expanding Hematoma Causing Iron-Deficiency Anemia in a Dog. J Am Anim Hosp Assoc 2014; 50:350-5. [DOI: 10.5326/jaaha-ms-6045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 2 yr old spayed female mixed-breed Irish wolfhound was referred for assessment of anemia and slowly progressing abdominal distention. At the time of admission, the dog had marked anemia and thrombocytosis, a decreased serum iron concentration, and a normal coagulation profile. An ultrasound examination showed a massive fluid-filled cavitated structure in the abdominal cavity. Paracentesis of that structure yielded a large amount of hemorrhagic fluid with an iron concentration >24 times greater than the serum iron concentration, consistent with chronic sequestration of iron, leading to iron-deficiency anemia. Blood transfusions and incomplete surgical removal of the structure allowed short-term stabilization of the patient, but the dog was euthanized 17 days postsurgery for lethargy and continued abdominal distention. Histopathological evaluation of the structure was consistent with a chronic expanding hematoma. To the authors’ knowledge, this is the first reported case of intra-abdominal chronic expanding hematoma in a dog. It is also unique given its features of iron-deficiency anemia caused by internal blood loss.
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Affiliation(s)
- Lionel Sebbag
- Veterinary Health Center (L.S., K.H., A.H., T.L.) and Veterinary Diagnostic Laboratory (S.G.), Kansas State University, Manhattan, KS
| | - Kenneth R. Harkin
- Veterinary Health Center (L.S., K.H., A.H., T.L.) and Veterinary Diagnostic Laboratory (S.G.), Kansas State University, Manhattan, KS
| | - Allison Habekost
- Veterinary Health Center (L.S., K.H., A.H., T.L.) and Veterinary Diagnostic Laboratory (S.G.), Kansas State University, Manhattan, KS
| | - Sanjeev Gumber
- Veterinary Health Center (L.S., K.H., A.H., T.L.) and Veterinary Diagnostic Laboratory (S.G.), Kansas State University, Manhattan, KS
| | - Tiffany Lee
- Veterinary Health Center (L.S., K.H., A.H., T.L.) and Veterinary Diagnostic Laboratory (S.G.), Kansas State University, Manhattan, KS
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Kitagawa Y, Yokoyama M, Tamai K, Takai S. Chronic expanding hematoma extending over multiple gluteal muscles associated with piriformis syndrome. J NIPPON MED SCH 2013; 79:478-83. [PMID: 23291848 DOI: 10.1272/jnms.79.478] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report on a patient with an unusual, slowly enlarging hematoma of the left buttock. A 62-year-old man presented with a 6-year history of an enlarging mass of the left buttock. He had first noted the mass 6 years earlier and had had sciatica of the left lower limb for the last 2 months. He denied any history of antecedent trauma. The lesion extended over 3 gluteal muscles (the gluteus medius, gluteus minimus, and piriformis). On microscopic examination, the lesion showed typical signs of chronic expanding hematoma. The sciatica was relieved after surgical removal of the lesion. The lesion had not recurred at the last follow-up 4 years after the operation. The present case suggested that chronic expanding hematoma can extend into multiple muscles due, perhaps, to long-term growth and the anatomical and functional conditions of the affected muscles. Our case also suggests that chronic expanding hematoma can be a cause of piriformis syndrome.
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Affiliation(s)
- Yasuyuki Kitagawa
- Department of Pediatrics, Tama Nagayama Hospital, Nippon Medical School, Tama, Tokyo, Japan.
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Syuto T, Hatori M, Masashi N, Sekine Y, Suzuki K. Chronic expanding hematoma in the retroperitoneal space: a case report. BMC Urol 2013; 13:60. [PMID: 24237992 PMCID: PMC3840719 DOI: 10.1186/1471-2490-13-60] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic expanding hematoma is a rare condition that develops after surgery, trauma, or injury. It can also develop at any location in the body in the absence of trauma. Clinical findings and various diagnostic imaging modalities can aid in the differential diagnosis of this condition. In general, hematomas are naturally reabsorbed and rarely cause serious problems. However, hematomas that develop slowly without a history of trauma, surgery, or bleeding disorders could be difficult to differentiate from soft tissue neoplasms. In the present case, we describe a patient, without any history or physical evidence of trauma, who exhibited a large chronic expanding hematoma in the retroperitoneal space that resulted in hydronephrosis because of the pressure exerted on the left ureter. CASE PRESENTATION A 69-year-old man presented to our hospital with a swollen lesion in the left flank. A mass, 19 cm in diameter, was detected in the retroperitoneal space by computed tomography. We suspected the presence of a chronic expanding hematoma, soft tissue tumor, or left renal artery aneurysm. Surgical treatment was performed. However, postoperative histopathological examination indicated that the mass was a nonmalignant chronic expanding hematoma. No recurrence was observed during a 2-year follow-up period. CONCLUSION In patients without a history of trauma who present slowly growing masses, the differential diagnosis should include chronic expanding hematoma in addition to cysts and soft tissue tumors. Moreover, the use of magnetic resonance imaging and computed tomography is essential to differentiate between chronic expanding hematoma and soft tissue tumors.
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Affiliation(s)
- Takahiro Syuto
- Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
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Tokue H, Tokue A, Okauchi K, Tsushima Y. 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG) positron-emission tomography (PET) findings of chronic expanding intrapericardial hematoma: a potential interpretive pitfall that mimics a malignant tumor. J Cardiothorac Surg 2013; 8:13. [PMID: 23324446 PMCID: PMC3560259 DOI: 10.1186/1749-8090-8-13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 01/14/2013] [Indexed: 11/19/2022] Open
Abstract
A 77-year-old man who had undergone mitral valve replacement 5 years previously presented with an intrapericardial mass. Computed tomography and magnetic resonance imaging showed that the mass lesion contained hematoma components. Positron-emission tomography (PET) with 2-[18 F] fluoro-2-deoxy-d-glucose (FDG) revealed uptake in the peripheral rim of the mass. These findings suggested the presence of hematoma associated with a malignant lesion. Surgical resection was performed, and the histological diagnosis was chronic expanding intrapericardial hematoma without neoplastic changes. Chronic expanding intrapericardial hematoma is a rare disease but should be considered when an expanding mass is found in a patient after cardiac surgery. The FDG-PET findings of chronic expanding hematomas, including FDG uptake in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall that mimics a malignant tumor.
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Affiliation(s)
- Hiroyuki Tokue
- Department of Diagnostic and Interventional Radiology, Gunma University Hospital, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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Rocha Oliveira PC, Martins BJ, Martins GL, Monteiro A, Batista KT. Imaging features of chronic expanding hematoma in the soft tissues of the hand simulating an aggressive lesion: case report. J Hand Surg Am 2011; 36:1343-6. [PMID: 21737211 DOI: 10.1016/j.jhsa.2011.05.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 05/24/2011] [Accepted: 05/25/2011] [Indexed: 02/02/2023]
Abstract
A chronic expanding hematoma can persist and increase in volume for more than 1 month after the first hemorrhage. It is rare, uncommon in the hand, little known among physicians, and an imitator of malignancy. Our purpose was to report a case of this condition in the soft tissues of an 8-year-old girl's hand that simulated an aggressive lesion, and to conduct a review on this subject.
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Affiliation(s)
- Paulo Cesar Rocha Oliveira
- Diagnostic Imaging Department, Sarah Hospital-Brasilia Center, Sarah Network of Rehabilitation Hospitals, Brasília, DF, Brazil.
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