1
|
Nakagawa M, Chiba N, Gunji T, Sano T, Tomita K, Shigoka M, Tabuchi S, Hidaka E, Nakatsugawa M, Kawachi S. Primary hepatic chronic expanding hematoma: a case report and literature review. Clin J Gastroenterol 2024; 17:484-489. [PMID: 38381261 DOI: 10.1007/s12328-024-01927-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 01/17/2024] [Indexed: 02/22/2024]
Abstract
Chronic expanding hematoma (CEH), first reported in 1968, is a hematoma that gradually enlarges over a long course of time after an initial period of bleeding. It can occur anywhere in the body; however, there are many reports of its occurrence in the thoracic cavity. Primary hepatic CEH is extremely rare. In this current study, we report on a case of primary hepatic CEH diagnosed preoperatively, with a review of the literature. A 68-year-old man presented with liver dysfunction. Abdominal computed tomography revealed a giant cystic tumor in the left lobe of the liver, with a longer axis of approximately 12 cm. Magnetic resonance imaging revealed a mosaic pattern with a mixture of high and low signals within the tumor on T1-weighted images and a high signal at the tumor margin on T2-weighted images. Based on these findings, primary hepatic CEH was suspected. However, other malignant tumors could not be excluded owing to tumor compression resulting in bile duct dilatation. Left trisectionectomy was performed, followed by bile duct drainage and percutaneous transhepatic portal vein embolization. Intraoperative hemorrhage was controlled by the Pringle maneuver and with temporary clamping of the inferior vena cava. Pathological examination revealed a pseudocyst containing a clot, consistent with CEH. In conclusions, the case report illustrates the potential to enhance preoperative diagnosis, inform surgical approaches, and minimize associated risks. Furthermore, it highlights the importance of increasing awareness and research on this condition for improved clinical decision-making and patient care.
Collapse
Affiliation(s)
- Masashi Nakagawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Naokazu Chiba
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan.
| | - Takahiro Gunji
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Toru Sano
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Koichi Tomita
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Masatoshi Shigoka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Satoshi Tabuchi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Eiji Hidaka
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| | - Munehide Nakatsugawa
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
- Department of Pathology, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Shigeyuki Kawachi
- Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi Hachioji, Tokyo, 193-0998, Japan
| |
Collapse
|
2
|
Inomata M, Kuroki S, Nakada H, Kawano F, Maeda R. Radiological features of intrathoracic chronic expanding hematoma: A case report. Int J Surg Case Rep 2023; 110:108767. [PMID: 37683511 PMCID: PMC10510069 DOI: 10.1016/j.ijscr.2023.108767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/27/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE We present a relatively rare case of intrathoracic chronic expanding hematoma (CEH) after thoracic surgery for lung cancer. CEH is often difficult to distinguish from malignant tumors because of its large size and slow progressive enlargement. In this report, we describe the radiological features of CEH in detail. CASE PRESENTATION A 67-year-old man who underwent a left upper lobectomy for lung cancer at 46 years of age presented with hemosputum. Computed tomography revealed a large mass with central low attenuation. Calcification was detected in peripheral lesions of the mass. T2-weighted magnetic resonance imaging (MRI) revealed a mass with mixed low and high signal intensities. Based on the clinical course, the patient was diagnosed with an intrathoracic CEH. A left posterolateral thoracotomy was performed with the patient in the lateral position, and a mass encased in a tough capsule was resected. The postoperative histopathological findings were consistent with CEH. CLINICAL DISCUSSION CT of intrathoracic CEH shows a lesion with heterogeneous content, a thick wall, and calcifications. However, differentiation from malignant tumors is difficult using CT alone. MRI is a good diagnostic modality for CEH and often shows a mixture of low- and high-intensity areas on T2-weighted images. In addition, the patient's medical history is important because most cases of CEH have a history of trauma or surgery. CONCLUSION To diagnose intrathoracic CEH, it is essential to consider the patient's clinical course and MRI findings.
Collapse
Affiliation(s)
- Mayu Inomata
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shoei Kuroki
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroshi Nakada
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Fumiya Kawano
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Ryo Maeda
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| |
Collapse
|
3
|
Ogata Y, Kumagai K, Mimura T, Miyahara S, Egawa M, Saito H, Amano Y, Yayama T, Kubo M, Imai S. Onset of Chronic Expanding Hematoma 25 Years After Total Hip Arthroplasty. Arthroplast Today 2023; 22:101168. [PMID: 37497549 PMCID: PMC10365973 DOI: 10.1016/j.artd.2023.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 07/28/2023] Open
Abstract
Chronic expanding hematoma (CEH) is a rare anatomical condition that gradually expands due to trauma or surgery. We report the case of a 56-year-old woman who developed CEH 25 years after metal-on-polyethylene total hip arthroplasty. She presented with swelling and radiating pain in the right inguinal region. Tocilizumab was administered for treating rheumatoid arthritis and renal amyloid A amyloidosis. Diagnostic imaging and partial resection revealed a soft tissue mass and a CEH, respectively. The symptoms recurred 6 months later; dialysis was initiated, and the CEH was resected under general anesthesia, leading to improvement. This case report emphasizes the importance of prompt diagnosis and intervention in CEH management for preventing further complications and improving the patient's quality of life.
Collapse
Affiliation(s)
| | - Kosuke Kumagai
- Corresponding author. Department of Orthopaedic Surgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan. Tel.: +81 77 548 2252.
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Miyasaka Y, Hiyama T, Kuno H, Shinozaki T, Sakashita S, Kobayashi T. Characteristic imaging findings in a patient with chronic expanding hematoma on the floor of the mouth. Int Cancer Conf J 2023; 12:185-189. [PMID: 37251013 PMCID: PMC10212869 DOI: 10.1007/s13691-023-00610-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Chronic expanding hematoma (CEH) is defined as chronic hematoma enlargement for more than 1 month. Although CEH rarely occurs on the floor of the mouth, the need to distinguish these cases from malignant disease is critical, given the need for potentially extensive resection in patients with malignancy. We report a case of CEH on the floor of the mouth, which required differentiation from malignant tumor. A 42-year-old woman was referred to our hospital for a submucosal mass on the right floor of the mouth, with a diagnosis of class 3 on aspiration cytology. Computed tomography revealed a submucosal mass with peripheral calcification on the floor of the mouth, which exhibited a hypointense rim on T2-weighted imaging and gradual nodular-like enhancement in the periphery on contrast-enhanced magnetic resonance imaging. Enucleation was performed to reach a definitive diagnosis, and CEH was confirmed pathologically. Well-defined morphology, presence of calcification, a hypointense rim on T2-weighted imaging, and weak peripheral nodular-like enhancement may be characteristic findings of CEH on the floor of the mouth. Accordingly, these imaging features may aid in differentiating CEH from low-grade malignancies and in determining the optimal management strategy.
Collapse
Affiliation(s)
- Yusuke Miyasaka
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan
| | - Takashi Hiyama
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan
| | - Hirofumi Kuno
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan
| | - Takeshi Shinozaki
- Department of Head and Neck Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan
| | - Shingo Sakashita
- Division of Pathology, Exploratory Oncology Research & Clinical Trial, National Cancer Center, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan
| | - Tatsushi Kobayashi
- Department of Diagnostic Radiology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577 Japan
| |
Collapse
|
5
|
Kitahara S, Kasai H, Sugiura T, Akimoto Y, Wada H, Suzuki H, Sakao S, Yoshino I, Suzuki T. Chronic Expanding Haematoma Causing Stenosis of the Right Ventricular Outflow Tract and Pulmonary Hypertension. Intern Med 2022. [PMID: 36261375 DOI: 10.2169/internalmedicine.0433-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A chronic expanding haematoma (CEH) is an encapsulated mass that gradually increases in size from repeated internal bleeding and neovascularization. We herein report a 69-year-old man who was admitted with dyspnoea on exertion after undergoing thymic carcinoma resection 17 years ago. Chest computed tomography showed a heterogeneous mass in the anterior mediastinum and compression of the right ventricle, and pulmonary artery. Right cardiac catheterisation revealed pulmonary hypertension that was relieved after resection of the diagnosed CEH mass. This report highlights the mechanism underlying anterior mediastinal CEH-induced stenotic compression of the right ventricle-pulmonary artery outflow and subsequent pulmonary hypertension.
Collapse
Affiliation(s)
- Shinsuke Kitahara
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
- Health Professional Development Center, Chiba University Hospital, Japan
- Department of Medical Education, School of Medicine, Chiba University, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Yuto Akimoto
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Hironobu Wada
- Department of Thoracic Surgery, International University of Health and Welfare Faculty of Medicine Graduate School of Medicine, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Seiichiro Sakao
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Japan
| |
Collapse
|
6
|
Yamashita A, Takeda Y, Fukui T, Tachibana T, Fukunishi S. Revision Total Hip Arthroplasty due to Catastrophic Osteolysis Caused by Massive Chronic Expanding Hematoma. Arthroplast Today 2021; 11:32-37. [PMID: 34458531 PMCID: PMC8377491 DOI: 10.1016/j.artd.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/12/2022] Open
Abstract
An 84-year-old woman who underwent bilateral cementless total hip arthroplasty (THA) for dysplastic osteoarthritis 22 years ago was subjected to analysis. A huge soft-tissue mass was revealed in her left medial thigh. Plain radiographs of the left hip joint revealed severe osteolysis around the stem, cup, and ischium. Magnetic resonance imaging showed a 25 × 14-cm multilobulated mass with a thick-walled pseudocapsule. Two-stage surgery was performed with resection of the mass followed by a subsequent revision THA. The mass was diagnosed as a chronic expanding hematoma through gross and histologic findings. Two years after the revision THA, there was no recurrence of a hematoma. Two-stage revision THA was useful for definitive diagnosis, and good functional recovery was obtained after surgery.
Collapse
Affiliation(s)
- Akihiro Yamashita
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, Japan
| | - Yu Takeda
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, Japan
| | - Tomokazu Fukui
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopedic Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo, Japan
| | - Shigeo Fukunishi
- Department of Orthopedic Surgery, Nishinomiya Kaisei Hospital, Nishinomiya City, Hyogo, Japan
| |
Collapse
|
7
|
Ono Y, Kariya S, Nakatani M, Ueno Y, Maruyama T, Komemushi A, Kaibori M, Ikeda M, Tanigawa N. Subcapsular hepatic hematoma: a case of chronic expanding hematoma of the liver. BMC Gastroenterol 2021; 21:241. [PMID: 34044783 PMCID: PMC8161977 DOI: 10.1186/s12876-021-01775-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background A chronic expanding hematoma (CEH) enlarges as a result of slight bleeding over several months, and the tissue shows a mixture of blood breakdown products, granulation tissue with capillary ingrowth, and inflammatory tissue. This report presents a case of a subcapsular hepatic CEH that was treated with transarterial embolization (TAE) and hepatectomy. Case presentation A 56-year-old man presented with vomiting and right-sided abdominal pain. Plain abdominal computed tomography (CT) showed a high-density area of fluid collection beneath the capsule of the right hepatic lobe, which was diagnosed as a hematoma. From its anatomical position on the CT images, a subcapsular hepatic hematoma was diagnosed. Though conservative therapy was provided, CT-guided percutaneous drainage and TAE were performed due to worsening symptom. Because the patient's abdominal symptoms re-appeared, extended right segmentectomy including the hematoma was performed. In the resected specimen, the hematoma was located beneath the capsule of the right hepatic lobe, and it was displacing the hepatic parenchyma. Microscopic examination showed a thick fibrous capsule around the hematoma, peripheral lymphocyte and plasmacyte invasion, and aggregations of histiocytes containing phagocytosed hemosiderin. Conclusions Anatomically, this was a case of a subcapsular hepatic hematoma, and pathologically it was shown to be a CEH. Complete surgical resection was effective treatment for this CEH.
Collapse
Affiliation(s)
- Yasuyuki Ono
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Shuji Kariya
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan.
| | - Miyuki Nakatani
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Yutaka Ueno
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Takuji Maruyama
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Atsushi Komemushi
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Masaki Kaibori
- Department of Surgery, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, 573-1010, Osaka, Japan
| | - Masatoshi Ikeda
- Department of The Third Internal Medicine, Kansai Medical University, 2-5-1, Shinmachi, Hirakata, 573-1010, Osaka, Japan
| | - Noboru Tanigawa
- Department of Radiology, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| |
Collapse
|
8
|
Masuda T, Harada K, Shimizu K, Karashima R, Nitta H, Matsumoto K, Okino T, Kamio T, Baba H, Takamori H. Rupture of a huge infectious abdominal chronic expanding hematoma. Clin J Gastroenterol 2021; 14:782-786. [PMID: 33830448 DOI: 10.1007/s12328-021-01366-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/09/2021] [Indexed: 12/01/2022]
Abstract
A 72-year-old woman was referred to our hospital with the diagnosis of peritonitis due to the rupture of a huge abdominal cystic tumor, 27 cm in diameter. Abdominal computed tomography 14 years before revealed the tumor, which was 18 cm in diameter. She had undergone no examinations or treatment in the interim. She was in shock upon presentation to our hospital. She was intubated immediately and underwent an emergent laparotomy. The huge ruptured tumor with adherent small intestine was resected. The tumor weighed 6 kg and consisted of solid and cystic components filled with 4 kg of brown feces-like fluid. Bacteroides fragilis was detected in a fluid specimen. The cystic component of the tumor was filled with old blood clots, and a portion of the tumor wall was highly calcified. Old blood and fibrin with blood vessels of various sizes inside the tumor were observed during the pathologic evaluation; there were no malignant features. The final pathologic diagnosis was a chronic expanding hematoma (CEH). The patient had an uneventful recovery and was discharged 16 days post-operatively. She was involved in a traffic accident approximately 30 years before the current hospital admission; however, she did not recall if she had abdominal pain at that time. A CEH is a benign lesion, but rupture of a CEH can be life-threatening.
Collapse
Affiliation(s)
- Toshiro Masuda
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan.
| | - Kazuto Harada
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Kenji Shimizu
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Ryuichi Karashima
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Hidetoshi Nitta
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Katsutaka Matsumoto
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Tetsuya Okino
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Takihiro Kamio
- Department of Pathology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| |
Collapse
|
9
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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.
| |
Collapse
|
10
|
Panagopoulos I, Gorunova L, Kostolomov I, Lobmaier I, Bjerkehagen B, Heim S. Chronic Expanding Hematoma with a t(11;19)(q13;q13) Chromosomal Translocation. Anticancer Res 2020; 40:97-100. [PMID: 31892557 DOI: 10.21873/anticanres.13930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Chronic expanding hematoma is defined as a hematoma that gradually expands over 1 month or longer, is without neoplastic features on histological sections, and does not occur in the setting of coagulopathy. The pathogenetic mechanism behind its development is unknown, nor is anything known about its genetic features. CASE REPORT A 49-year-old man noted a tender lump close to the right femoral trochanter. Examination of a core needle biopsy showed a fibrous capsule with fibrinoid material on one side. The patient underwent surgery with removal of a cystic, encapsulated structure with central bleeding and proliferating vessels in the fibrous capsule. The reactive fibroblasts were without any sign of atypia. Genetic analyses were performed on this chronic expanding hematoma. RESULTS G-Banding analysis of short-term cultured cells from the chronic expanding hematoma yielded a karyotype with a single clonal chromosome abnormality: 46,XY,t(11;19)(q13;q13)[8]/46,XY[10]. RNA sequencing and examination of the sequencing data using five different programs did not identify fusion genes related to the translocation. CONCLUSION The acquired translocation t(11;19)(q13;q13) suggested that chronic expanding hematoma is a neoplastic lesion. Since the translocation did not lead to any fusion genes, one can speculate that it causes deregulation of gene expression.
Collapse
Affiliation(s)
- Ioannis Panagopoulos
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ludmila Gorunova
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ilyá Kostolomov
- Section for Applied Informatics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Ingvild Lobmaier
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Bodil Bjerkehagen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Institute of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Sverre Heim
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Lee JS, Jeon HJ, Lee J, Park HY, Yang JD. Treatment of late solidified hematoma in back donor site after breast reconstruction with latissimus dorsi flap: report of three cases. BMC Surg 2019; 19:51. [PMID: 31109327 PMCID: PMC6528295 DOI: 10.1186/s12893-019-0516-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/14/2019] [Indexed: 11/29/2022] Open
Abstract
Background Late solidified hematoma is a rare complication of breast reconstruction with latissimus dorsi (LD) flap. The majority of hematomas occur in the immediate postoperative period; however, some cases can occur at a distant point in time after surgery and do not have a definitive mechanism of injury or develop symptoms immediately after the triggering event. Moreover, treatment of hematoma has not yet been established. Case presentation Breast reconstruction with LD flap has been performed between January 2014 and June 2018 in more than 275 cases. We report 3 cases of late solidified hematoma at the back-donor site that have developed years after breast reconstruction with LD flap, in which a surgical approach was performed because the solidified hematomas could not be treated with percutaneous aspiration. Conclusions We report successful surgical treatment and histological findings of late-onset solidified hematoma as a rare complication of Breast reconstruction with LD flap.
Collapse
Affiliation(s)
- Joon Seok Lee
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, South Korea
| | - Hyeon Jun Jeon
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, South Korea
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Hoguk-ro 807, Buk-gu, Daegu, 41404, South Korea
| | - Ho Yong Park
- Department of Surgery, School of Medicine, Kyungpook National University, Hoguk-ro 807, Buk-gu, Daegu, 41404, South Korea
| | - Jung Dug Yang
- Department of Plastic and Reconstructive Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu, 700-421, South Korea.
| |
Collapse
|
12
|
Morishita M, Hara H, Katayama E, Kawamoto T, Fukase N, Takemori T, Fujiwara S, Nishida K, Kuroda R, Akisue T. Huge chronic expanding hematoma of the iliac bone following multiple hip surgeries: a case report. J Med Case Rep 2018; 12:265. [PMID: 30176925 PMCID: PMC6122718 DOI: 10.1186/s13256-018-1783-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 07/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Chronic expanding hematoma is a rare entity resulting from trauma or surgery. This condition usually occurs in soft tissue, such as the trunk or extremities, while chronic expanding hematoma arising from bone has not been reported previously. We describe an unusual case of a huge intraosseous chronic expanding hematoma arising from the ilium, which had grown over a 40-year period following hip surgeries. Case presentation A 57-year-old Japanese woman presented with a 1.5-year history of right hip pain. She had a history of bilateral developmental dysplasia of the hip and had undergone bilateral arthroplasties in childhood. A physical examination revealed a large, firm, immobile mass at her right ilium. Based on radiographic findings, a type of slow-growing bone tumor was suspected, and an incisional biopsy was performed. A histopathologic examination revealed large amounts of old clotted blood within the lesion, and the capsule of the lesion was composed of dense, fibrous, connective tissue. There was no evidence of neoplasia, and chronic expanding hematoma was suspected. The lesion was resistant to conservative treatment, and so we performed an internal hemipelvectomy (including the capsule of the mass) and a reconstruction by hip transposition 2.5 years after the incisional biopsy. There was no recurrence of chronic expanding hematoma at the most recent follow-up of 1 year and 8 months postoperatively. Conclusions A chronic expanding hematoma is characterized by its persistence and increasing size more than 1 month after the trauma or surgical event suspected of causing hemorrhage. To the best of our knowledge, this is the first report of chronic expanding hematoma arising from bone. We performed internal hemipelvectomy and hip transposition, and there has so far been no recurrence. This disease may be considered a differential diagnosis for bone tumor when the patient has a history of surgery or trauma, regardless of how many years have passed since the index event.
Collapse
Affiliation(s)
- Masayuki Morishita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Etsuko Katayama
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Teruya Kawamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Division of Orthopaedic Surgery, Kobe University International Clinical Cancer Research Center, 1-5-1 Minatojimaminami-cho, Chuo-ku, Kobe, 650-0047, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshiyuki Takemori
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shuichi Fujiwara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshihiro Akisue
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, 7-10- 2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
| |
Collapse
|
13
|
Jahed K, Khazai B, Umpierrez M, Subhawong TK, Singer AD. Pitfalls in soft tissue sarcoma imaging: chronic expanding hematomas. Skeletal Radiol 2018; 47:119-124. [PMID: 28887645 DOI: 10.1007/s00256-017-2770-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 02/02/2023]
Abstract
Solid or nodular enhancement is typical of soft tissue sarcomas although high grade soft tissue sarcomas and those with internal hemorrhage often appear heterogeneous with areas of nonenhancement and solid or nodular enhancement. These MRI findings often prompt an orthopedic oncology referral, a biopsy or surgery. However, not all masses with these imaging findings are malignant. We report the multimodality imaging findings of two surgically proven chronic expanding hematomas (CEH) with imaging features that mimicked sarcomas. A third case of nonenhancing CEH of the lower extremity is also presented as a comparison. It is important that in the correct clinical scenario with typical imaging findings, the differential diagnosis of a chronic expanding hematoma be included in the workup of these patients. An image-guided biopsy of nodular tissue within such masses that proves to be negative for malignancy should not necessarily be considered discordant. A correct diagnosis may prevent a morbid unnecessary surgery and may indicate the need for a conservative noninvasive follow-up with imaging.
Collapse
Affiliation(s)
- Kiarash Jahed
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Behnaz Khazai
- Department of Radiology, University of Miami, Miami, FL, USA.
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| | - Ty K Subhawong
- Department of Radiology, University of Miami, Miami, FL, USA
| | - Adam D Singer
- Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA, USA
| |
Collapse
|
14
|
Torikai H, Inoue M, Nakatsuka S, Tamura M, Yashiro H, Yoshitake A, Shimizu H, Jinzaki M. Imaging Findings of Atypical Type II Endoleak Through Vasa Vasorum After Abdominal Endovascular Aneurysm Repair. Cardiovasc Intervent Radiol 2018; 41:186-90. [PMID: 28861600 DOI: 10.1007/s00270-017-1778-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/22/2017] [Indexed: 10/19/2022]
Abstract
A type II endoleak (T2EL) is the most common endoleak after endovascular aneurysm repair (EVAR), and a persistent T2EL has been occasionally associated with aneurysmal enlargement. Typical findings of a T2EL consist of an endoleak cavity with inflow and outflow arteries of aortic branch vessels. However, an atypical T2EL, in which hypertrophied vasa vasorum and enlargement of a thrombosed aneurysm are observed, has no endoleak cavity. We have seen three cases of continuous aortic aneurysmal growth after EVAR caused by atypical T2ELs without endoleak cavities through developed vasa vasorum. In this report, the imaging findings of selective angiography and dynamic computed tomography of these cases are reviewed.
Collapse
|
15
|
Abstract
A chronic expanding hematoma is a hematoma with long term, continuous growth. A 69-year-old male presented with an extra-thoracic chronic expanding hematoma 45 years after thoracoplasty. Six months prior to his visit with us, he had noticed a slight swelling on his back. Three months before his visit with us, the size of the swollen area gradually increased after bowling. Magnetic resonance imaging (MRI) showed an extra-thoracic lesion measuring 120 mm in diameter. Heterogeneous signal intensity on T1- and T2-weighted images inside the lesion was reflected as hematoma of various ages. The hematoma was successfully resected after preoperative embolization. Chronic expanding hematoma can be a delayed complication after thoracoplasty.
Collapse
Affiliation(s)
- Akio Sakamoto
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
16
|
Tatsuta S, Morioka D, Murakami N, Ohkubo F. Chronic Expanding Hematoma Following Abdominoplasty. Aesthetic Plast Surg 2017; 41:117-120. [PMID: 28035446 DOI: 10.1007/s00266-016-0740-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
Chronic expanding hematoma (CEH) is a relatively rare complication of trauma or surgery. We report a patient with CEH as a late complication of abdominoplasty. A 58-year-old woman underwent conventional abdominoplasty and thereafter refused to use a compression binder, citing discomfort. One month postoperatively, she presented with a gradually enlarging, painful abdominal mass. The results of ultrasonography and computed tomography were highly suspicious for CEH. The lesion was completely removed, together with surrounding fibrous tissue. Histopathology revealed a chronic hemorrhage collection with a fibrous capsule, consistent with CEH. This condition as a late complication of abdominoplasty has not previously been reported in the literature. However, an online medical consultation site features several abdominoplasty patients asking about persistent hematomas that sound suspicious for CEH. CEH might be underdiagnosed by surgeons. Although a postoperative binder may increase the risk of skin necrosis and deep vein thrombosis, appropriate compression treatment is necessary to prevent hematoma formation. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
17
|
Basha KMS, Palanisamy V, Janakiraman E, Jamesraj J, Pandian S, Sangili SK, Ajit Sankardas M. A rare presentation of intrapericardial hematoma 20 months post aortic valve replacement. Indian Heart J 2015; 67:148-51. [PMID: 26071296 DOI: 10.1016/j.ihj.2015.02.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 10/09/2014] [Accepted: 02/19/2015] [Indexed: 11/29/2022] Open
Abstract
We report the successful treatment of a rare case of chronic intrapericardial hematoma which presented with congestive cardiac failure 20 months after aortic valve replacement surgery for severe calcific aortic stenosis. Chest roentgenograph demonstrated paracardiac mass over lower left ventricle border, left pleural effusion and pulmonary venous hypertension. An echocardiographic study demonstrated intrapericardial mass posterolateral to left ventricle compressing left ventricular cavity both during systole and diastole causing septum to bulge into right ventricle. Computed tomography showed a loculated pericardial mass in left heart margin, left pleural effusion, bilateral axillary and mediastinal lymphadenopathy. Surgical resection was planned to relieve the symptoms and to confirm the diagnosis of the mass. The mass was completely resected through left anterolateral thoracotomy and histopathology findings confirmed the diagnosis of hematoma with cystic degeneration. Postoperative course was uneventful, and his symptoms improved markedly.
Collapse
Affiliation(s)
- Khadhar Mohamed Sarjun Basha
- Senior Registrar, Department of Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India.
| | - Vijayanand Palanisamy
- Registrar, Department of Cardiothoracic Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| | - Ezhilan Janakiraman
- Senior Consultant, Department of Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| | - Jacob Jamesraj
- Senior Consultant, Department of Cardiothoracic Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| | - Sivakumar Pandian
- Consultant, Department of Cardiothoracic Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| | - Suresh Kumar Sangili
- Consultant, Department of Cardiothoracic Surgery, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| | - Mullasari Ajit Sankardas
- Director, Department of Cardiology, Institute of Cardiovascular Diseases, The Madras Medical Mission, Chennai, India
| |
Collapse
|
18
|
Sevy B, Stanley DP, Doctry NE, Chernev I. Chronic expanding hematoma of the calf. Joint Bone Spine 2014; 82:131-2. [PMID: 24962981 DOI: 10.1016/j.jbspin.2014.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 04/22/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Bradley Sevy
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA
| | - Dirk P Stanley
- Department of Medicine, Appalachian Regional Healthcare, Beckley, WV, USA
| | - Nathan E Doctry
- Department of Surgery, Appalachian Regional Healthcare, Beckley, WV, USA
| | - Ivan Chernev
- West Virginia School of Osteopathic Medicine, Lewisburg, WV, USA; Department of Medicine, Appalachian Regional Healthcare, Beckley, WV, USA.
| |
Collapse
|
19
|
Morioka D, Ohkubo F, Umezawa K. Chronic expanding hematoma, ruptured through the skin 53 years after buttock contusion. Int J Surg Case Rep 2014; 5:342-4. [PMID: 24814983 DOI: 10.1016/j.ijscr.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 01/20/2014] [Accepted: 03/04/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Chronic expanding hematoma is a relatively rare complication of soft tissue trauma and often clinically mistaken for a malignant neoplasm. PRESENTATION OF CASE A 71-year-old female presented with a chronic expanding hematoma that ruptured through the buttock skin 53 years after the original contusion. The diagnosis of CEH was made based on the results of the biopsy, physical examination, and CT. The tumor was completely excised, and the defect was covered with a rhomboid flap. DISCUSSION There are no reports of lesions rupturing through the skin. Almost all instances of chronic expanding hematoma previously reported in the English literature have a history ranging from 1 month to 20 years. There is a report of a thorax CEH that ruptured into the lung parenchyma after 24 years, so it is conceivable that other subcutaneous CEHs could break through the skin several decades after their inception. CONCLUSION Once this lesion has ruptured, its differentiation from other entities becomes more complicated.
Collapse
|
20
|
Ito T, Nakahara T, Takeuchi S, Uchi H, Takahara M, Moroi Y, Furue M. Four cases of successfully treated chronic expanding soft tissue hematoma. Ann Dermatol 2014; 26:107-10. [PMID: 24648696 PMCID: PMC3956774 DOI: 10.5021/ad.2014.26.1.107] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/08/2011] [Accepted: 10/27/2011] [Indexed: 11/08/2022] Open
Abstract
Chronic expanding hematoma (CEH) is a rare, slow-developing disease that occurs months to years after trauma or surgery. Most CEH in soft tissue occurs in the thigh or upper extremities and can occur with or without an inducible cause. Ninety-one cases of CEH in soft tissue have been reported previously in the Japanese and English literature but its occurrence on the sole has not been reported. Here, we report four cases of successfully treated CEH, including a case occurring on the sole, and provide a review of the literature.
Collapse
Affiliation(s)
- Takamichi Ito
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Nakahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Satoshi Takeuchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Uchi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masakazu Takahara
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoichi Moroi
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masutaka Furue
- Department of Dermatology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
21
|
Hojo M, Goto M, Miyamoto S. Chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy. Surg Neurol Int 2013; 4:41. [PMID: 23607063 PMCID: PMC3622356 DOI: 10.4103/2152-7806.109654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 03/05/2013] [Indexed: 11/19/2022] Open
Abstract
Background: Enlargement of intracerebral hematoma without rebleeding in chronic phase is a rare but well-known clinical condition, and is well-described as chronic expanding intracerebral hematoma. However, chronic enlargement of pituitary hematoma without rebleeding after pituitary apoplexy is extremely rare. Case Description: We report a case of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy. A 29-year-old male presented with sudden onset of headache and vomiting. Magnetic resonance imaging (MRI) demonstrated a pituitary mass lesion with hematoma, consistent with pituitary apoplexy. Neuro-ophthalmological examination revealed no visual field defect, and endocrinological evaluations showed an elevated prolactin level. Pituitary apoplexy due to a prolactinoma was the most likely diagnosis. He was conservatively treated because he exhibited no visual disturbance. Three weeks after the onset, he gradually began to complain of blurred vision and neuro-ophthalamological examination revealed bitemporal upper quadrant hemianopsia. MRI showed enlargement of the pituitary hematoma without any finding suggestive of rebleeding. This enlarged mass lesion compressed the chiasm. The patient was operated on via transsphenoidal approach. After dural opening, xanthochromic fluid spouted out, but no fresh clot could be detected within the cyst. After the operation, the visual field disturbance resolved completely. The possible mechanism of hematoma enlargement is considered to be expansion due to the serum exudation from capillaries of the hematoma capsule. This pathogenetic mechanism is common in enlargement of chronic subdural hematoma. Conclusions: This case is the first report of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy.
Collapse
Affiliation(s)
- Masato Hojo
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | | | | |
Collapse
|
22
|
Hata Y, Sakamoto S, Shiraga N, Sato K, Sato F, Otsuka H, Goto H, Takagi K, Watanabe Y. A case of chronic expanding hematoma resulting in fatal hemoptysis. J Thorac Dis 2012; 4:508-11. [PMID: 23050116 DOI: 10.3978/j.issn.2072-1439.2012.08.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/21/2012] [Indexed: 11/14/2022]
Abstract
An 80-year-old woman presented with a huge intrathoracic mass which had increased in size over 4 years. Computed tomography showed a thick calcified capsule and early-enhanced streaks inside the mass. Needle biopsy aspirated pure blood and fibrous connective tissue. F-18 fluorodeoxyglucose positron-emission tomography showed moderate FDG uptake at the periphery with central photon defects. Gallium-67 scintigraphy showed no abnormal uptake. On suspicion of chronic expanding hematoma, we recommended surgical resection, but the patient requested only follow-up. One year later, she was hospitalized with cardiac tamponade and subsequent massive hemoptysis. Repeated embolization was ineffective, and the patient soon succumbed.
Collapse
Affiliation(s)
- Yoshinobu Hata
- Department of Chest Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Okamoto M, Yamada T, Amano T, Matsuoka S, Hirai H, Masuda K, Sueyoshi A. Development of a tennis ball-sized tumor at the site of an implanted pacemaker. J Cardiol Cases 2010; 2:e151-e153. [PMID: 30532817 DOI: 10.1016/j.jccase.2010.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2010] [Revised: 05/30/2010] [Accepted: 06/10/2010] [Indexed: 11/19/2022] Open
Abstract
A 77-year-old woman who had undergone a pacemaker implantation 6 years previously developed a tumor on the left side of the chest. The mass gradually grew to the size of a tennis ball and was excised along with the pacemaker generator. Histopathological examination revealed that the mass was a chronic expanding hematoma. Although carcinogenesis occurring around a pacemaker has been reported previously, the development of a hematoma has not been reported. Thus, we suggest that when a patient has a mass in the proximity of a pacemaker, chronic expanding hematoma should be considered as one of the differential diagnoses.
Collapse
Affiliation(s)
- Masashi Okamoto
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Takuji Yamada
- Institute of Pathology, Uji Tokushukai Hospital, Kyoto, Japan
| | - Tomonori Amano
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Shunzou Matsuoka
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Hideki Hirai
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Kazunori Masuda
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| | - Atsushi Sueyoshi
- Department of Cardiovascular Medicine, Uji Tokushukai Hospital, 86 Kasugamori, Ogura-cho, Uji-shi, Kyoto 611-0042, Japan
| |
Collapse
|