Massive gluteal mass mimicking sarcoma: Chronic expanding hematoma

Chronic expanding hematomas (CEH) are rare presentation of hematomas characterized by its long-term persistence and chronic expansion. It had been a challenge for clinicians to differentiate CEH from hemorrhagic neoplasms, both clinically and radiologically. In Case 1, patient was presented with a massive gluteal mass lasting for 5 years. In our diagnostic approach, magnetic resonance imaging and ultrasound-guided biopsy helped us to get the initial impression of the mass and direct the surgical planning. Definitive diagnosis was done by pathological examination. In Case 2, the patient was presented with a intraooseous chronic expanding hematoma of the left ilium. The patient was treated with an endoscopic assisted tumor excision and prolonged drainage to preserve the live quality and function of the patient. After reviewing the related articles, we conclude that when CEH is suspected, especially in presence of history of trauma, early excision remains the gold standard for treatment. From the present researches on the cellular effects of blood breakdown products, we also suggest early intervention of chronic hematomas to avoid chronic expansion and associated bony destruction.     

Imaging features of chronic expanding hematoma in the soft tissues of the hand simulating an aggressive lesion: case report

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.     

Chronic expanding hematoma,ruptured through the skin 53 years after buttock contusion

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.     

Chronic expanding hematoma after spinal surgery

Background context

Chronic expanding hematoma after spinal surgery is extremely rare, with no case previously reported in the literature.

Purpose

To report a rare case of a chronic expanding hematoma of the spine that occurred 24 years after thoracic laminectomy and spinal cord tumor resection.

Study design

Case report.

Methods

A 71-year-old man presented with a spinal mass located approximately at the level of the sixth thoracic vertebral body. The patient had undergone thoracic laminectomy with tumor resection 24 years previously. The mass had appeared 5 years after this and had gradually enlarged over 19 years.

Results

The tumor was resected en bloc. The lamina and spinous processes had been partially eroded by the tumor at the fifth and sixth thoracic vertebrae, but the dura was intact. Histopathologic examination confirmed the diagnosis of chronic expanding hematoma. The hematoma had not recurred at the 1-year follow-up.

Conclusion

We report herein an extremely rare case of chronic expanding hematoma after spinal surgery. This entity may be considered a late complication after surgery regardless of the number of years that have passed since the index surgery.     

Chronic extradural hematoma

Thirty-five patients with late extradural hematomas are described in whom the interval between injury and operation was at least seven days. Interpersonal violence was responsible for the initial injury in about two-thirds of the cases. There was a uniformly favorable outcome in all the cases. The mode of presentation, features of the computed tomographic (CT) scans, and the possible mechanism of formation of chronic extradural hematomas are discussed.     

慢性扩展性脑内血肿18例临床分析

目的 总结慢性扩展性脑内血肿的诊断与治疗经验。方法 对18例慢性扩展性脑内血肿的临床资料进行回顾性分析。结果 多数病变术前误诊为脑肿瘤。术后15例痊愈，2例重残，1例死亡。结论 脑内有包膜的占位性病变应考虑慢性扩展性脑内血肿的可能，最后诊断需手术及病理证实。     

Thoraco-pleuropneumonectomy for rupture of a huge chronic hematoma of the thorax

A 67-year-old woman with a huge chronic expanding hematoma of the thorax due to previous tuberculous pleuritis was referred to our hospital with frequent hemoptysis. The hematoma had ruptured into the lung parenchyma. The patient had undergone apical thoracoplasty 40 years earlier. To provide complete resection of the huge cavity in the costodiaphragamatic recess, thoraco-pleuropneumonectomy was performed, and the patient was able to resume daily activities a few months after the operation.     

Chronic expanding epidural haematoma

Summary An encapsulated fluid epidural haematoma in a 9-year-old boy was successfully evacuated by a simple burr hole procedure 5 months after a minor head injury. Clinicopathological findings suggested that chronic expansion of an initially unsuspected epidural haematoma occurred as a result of repeated haemorrhages from the haematoma membrane, resulting in an unusually long delayed appearance of clinical evidence. This case demonstrates that a chronic expanding process similar to that seen in chronic subdural haematoma needs to be considered as a possible complication of epidural haematoma and indicates an important role for the haematoma membrane in the chronic expansion of epidural haematoma.     

Chronic expanding hematoma with feeding artery in the gluteus maximus muscle

A case of chronic expanding hematoma which had a clear feeding artery from the inferior gluteal artery was presented. Chronic expanding hematoma with feeding artery demonstrated by preoperative MRI imaging is very rare. Hypervascular mass and feeding arteries in image findings raised the suspicion of a malignant soft tissue tumor or a vascular malformation with repeated bleeding as differential diagnosis. A massive bleeding over 500 mL was observed during the partial resection for biopsy, indicating that the mass and its outer envelope had an abundant blood flow. Before operation, embolization of the feeding artery was performed. The patient underwent a complete surgical resection, and the mass was resected with minimal bleeding less than 20 mL. Preoperative embolization was very effective for controlling bleeding in this case.Level of Evidence: Level V, therapeutic study.     

Chronic expanding hematoma in the chest

We report the successful surgical treatment of chronic expanding hematoma in the chest. Four patients who had previously undergone artificial pneumothorax, thoracoplasty or tumor extirpation more than 30 years earlier recently became aware of a slowly growing mass. Chronic expanding hematoma which developed into very large masses over a long period of time were thus successfully resected. These patients are now all in good health with no recurrence after the operation. It is important to monitor such patients' laboratory data for hemostasis including the platelet cell counts, the % prothrombin time and the D-dimer, both before and immediately after operation, and the intraoperative bleeding volume.     

Chronic Subdural Hematoma―Evolution of Etiology and Surgical Treatment―

In this paper, I review the historical changes in the etiological concepts and surgical treatments for chronic subdural hematoma (CSDH) across the world and in Japan. I also examine future problems associated with its surgical procedures and medical costs. CSDH was first reported by Wepfer in 1657 as “delayed apoplexy.” In 1857, Virchow described the famous concept of so-called “pachymeningitis hemorrhagica interna.” He considered that the etiology of CSDH involved inflammation. In 1914, Trotter described the origin of CSDH as traumatic. Currently, CSDH is considered to arise with a first leak of blood from dural border cells after mild trauma. Inflammatory cells are then drawn to the border cell layer. At this point, new membranes form from activated inflammation; then, the hematoma enlarges, promoted by angiogenic factors and new capillaries. In 1883, Hulke reported successful trepanning of a patient with CSDH. Burr holes and craniotomy for removal of the hematoma were subsequently reported, and new methods were developed over the course of several decades around the world. In Japan, after the first report by Nakada in 1938, many Japanese pioneering figures of neurological surgery have studied CSDH. After Mandai reported the middle meningeal artery embolization in 2000, this method is now considered useful as an initial or second treatment for CSDH. However, the age of patients is increasing, so more minimally invasive surgeries and useful pharmacotherapies are needed. We must also consider the costs for treating CSDH, because of the increasing numbers of surgical cases.     

Cellular composition of the initial fracture hematoma compared to a muscle hematoma: A study in sheep

Bone fracture leads to a cycle of inflammation, cellular migration, and proliferation to restore tissue integrity. Immune cells at the site of injury are involved especially in the early phase of the healing process, but little is known about the cells present in the initial fracture hematoma. The hypothesis of this study was that the cellular composition in a fracture hematoma differs from that found in a muscle hematoma and that these divergences get more pronounced over time. By using a reproducible osteotomy model and muscle trauma in sheep the distributions of the immune cell subpopulations were evaluated 1 and 4 h after surgery. The cell amount within the first 4 h increased in both hematoma. The number of dead cells was higher in the muscle hematoma. One hour postoperatively the initial fracture hematoma revealed a lower granulocyte percentage compared to the muscle hematoma. The ratio of T helper to cytotoxic T cells was higher in the fracture hematoma compared to the muscle hematoma at both investigated time points. B cell percentage increased in the fracture but not in the muscle hematoma from 1 to 4 h. This is the first study that compares the immune cell subpopulations of a fracture and muscle hematoma. © 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res     

Chronic Expanding Hematoma of the Lateral Thigh and Massive Bony Destruction After a Failed Total Hip Arthroplasty

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

Chronic epidural hematoma of the vertex: problems in detection with computed tomography

A vertex epidural hematoma of a 21-year-old man was diagnosed by angiography 1 month after head trauma. Two axial computed tomography scans did not reveal the lesion, whereas a coronal computed tomography scan demonstrated the hyperdense hematoma. The problems of detecting vertex lesions with axial computed tomography scans are discussed.     

Chronic expanding hematoma in the pericardial cavity after cardiac surgery

We report the successful surgical treatment of a rare case of chronic expanding hematoma in the pericardial cavity that developed into a very large mass over a long period. The patient, who had a history of cardiac surgery for a double-outlet right ventricle 14 years previously and for tricuspid regurgitation 8 years ago, noticed a slowly growing mass near the left atrium and ventricle 5 years ago. The mass, which confirmed a diagnosis of chronic expanding hematoma, was resected by left thoracotomy.     

颜面部皮肤扩张术后残缺的修复

目的:采用自体显微毛囊移植技术对接受颜面部皮肤扩张术治疗后出现毛发残缺的的患者进行进一步修复,以便获得更为满意的疗效。方法:运用自体显微毛囊移植技术进行部分或全部眉、胡须(含上、下唇、颏、下颌)再造修复,毛囊供区位于耳后或枕部头皮。上述治疗均在扩张术治疗半年以后进行。结果:运用自体显微毛囊移植技术进行部分或全部眉再造共10例13侧;胡须再造(含上、下唇、颏、面颊和下颌)12例,疗效满意。结论:采用自体显微毛囊移植技术对接受颜面部扩张术治疗后出现毛发残缺的患者进行进一步修复可以取得良好效果。     

Acute epidural hematoma developing during twist-drill craniostomy: a complication of percutaneous subdural tapping for the treatment of chronic subdural hematoma

BACKGROUND

This case illustrates that although percutaneous subdural tapping for patients with chronic subdural hematoma (CSDH) is successful and minimally invasive, it can be complicated by acute epidural hematoma.

CASE PRESENTATION

A 62-year-old woman presented with headache two months after minor head trauma. Computed tomography (CT) scanning revealed CSDH with mixed density on the right side. Prior to percutaneous subdural tapping, twist-drill craniostomy was performed at the parietal tuber. When the drill-needle reached the dura mater, the patient began to complain of headache, which was followed by altered consciousness. CT scanning disclosed acute epidural hematoma abutting the CSDH; both hematomas were evacuated by emergency craniotomy. At surgery, no definite bleeding source was identified apart from oozing on the dura mater.

CONCLUSION

Hemorrhagic complications after percutaneous subdural tapping are rare. The formation of acute epidural hematoma during twist-drill craniostomy has not been reported in the literature. This complication can occur when the blunt tip of the drill-needle remains on the dura mater without penetrating into the subdural hematoma cavity.     

皮肤正交各向异性及扩张器力学特性对皮肤扩张的影响

目的:研究皮肤正交各向异性及扩张器力学特性对皮肤扩张的影响,为临床扩张器置入及扩张皮瓣的设计提供参考.方法:以朗格氏线(Langer's lines)为X轴,Y轴垂直于朗格氏线,测量计算注水前后两轴单位皮肤扩张量,测量分析扩张器囊壁的张力特征.结果:Y轴单位皮肤扩张量注水前后明显大于X轴;扩张器其囊壁在各个方向上单位延展量与其形状有关.结论:皮肤扩张时,在各个方向上扩张效率并不一致,沿朗格氏线方向扩张效率最低,而沿垂直于朗格氏线方向扩张效率最高,扩张期张力特性对皮肤扩张存在较大影响.     

腰大肌间隙神经阻滞的临床应用

目的 了解腰大肌间隙神经阻滞的临床应用。方法 根据腰大肌间隙及周围组织的解剖特点，分析腰大肌间隙神经阻滞的适应症、操作方法及治疗中所出现的临床表现及防治。结论 腰大肌间隙神经阻滞在治疗腰腿痛方面有一定的临床疗效。虽存在着一些潜在危险，但只要认真掌握操作要领，仍不失是一种较理想的治疗方法。