How to distinguish between bleeding and coagulated extradural hematomas on the plain CT scanning

Summary Four types of extradural hematoma could be separated at examination of the plain CT scan in 54 extradural hematomas. Two major groups appear: the still bleeding hematoma showing either generally low attenuation values of holes, and a coagulated homogeneous type with generally high attenuation values. The attenuation values of the bleeding-liquid part of hematoma — were correlated to hemoglobin concentration in blood, to which clots were not related. Seven extradural hematomas grew and coagulated on repeated preoperative CT scans. In two cases intravenous contrast was given to the bleeding type of hematoma, and the contrast media appeared in holes, but not in areas of high attenuation value. It is easy to distinguish between the different types of hematoma on the plain CT scan, and the separation by eye between the still bleeding and the coagulated extradural hematoma seems reliable.Parts of the paper were presented at the Meeting on Recent Advances in Neurotraumatology, Edinburg, 1982     

急性硬膜外血肿脑疝后不同时间手术与预后关系的临床研究

总结186例急性硬膜外血肿脑疝后不同时间手术与预后的经验,提示急性硬膜外血肿瞳孔散大后手术减压时间越早,预后越好.     

Extractable iron in experimental hematomas

Summary The extractable iron and total iron were determined in experimental, subcutaneous hematomas (5 ml blood) of rats after different periods of vital time. The extractable iron was determined from homogenate extract obtained after 24-h incubation with concentrated HCl diluted 1:3 and protein precipitation. For the determination of total iron, the specimens were wet-ashed. The same iron determinations were also made for the corresponding control specimens of the subcutaneous tissue. Extractable iron started to rise over the control values in 2-day-old hematomas, being about 5 times higher after 3 days, about 15 times higher after 7 days, and about 20 times higher after 14 days. The ratio of extractable iron and total iron expressed as percentages was about 1% in 1-h and in 1-day-old hematomas, about 20% in 3-day-old hematomas, about 50% in 7-day-old hematomas, and about 65% in 14-day-old or older hematomas. The effect of autolysis for 3 days at room temperature was studied on 1-h-old hematomas. Extractable iron values were slightly higher in the autolyzed specimens, but the difference was statistically insignificant as compared to specimens taken immediately after death.     

Chronic subdural hematomas

Summary Surgery was undertaken on 32 chronic subdural hematomas in a series of 28 patients who had preoperatively undergone delayed contrast-enhanced computed tomography (DCECT). Timedensity curves on DCECT and iodine concentrations of subdural specimens revealed that chronic subdural hematomas, regardless of density, were significantly enhanced by the entrance of intravascular contrast medium into the interior of hematomas. The ingress of intravascular contrast medium into the interior of the hematomas was chemically proven and might result from a complex transcapillary shift.     

Hemoglobin-degrading enzymes in experimental subcutaneous hematomas

Summary The activities of heme oxygenase and biliverdin reductase were determined in subcutaneous (s.c.) hematomas of rats after different periods of vital time. The postmortem stabilities of the heme-degrading enzymes were also studied by keeping the rats with vital hematomas for 1–5 days at temperatures of +4°C and +22°C. A tenfold increase of heme oxygenase activity over the starting level was observed in 2–9-day-old vital hematomas, when the specimens were taken immediately after death. Biliverdin reductase showed only negligible changes. Postmortally, heme oxygenase activity started to decrease in hematomas immediately at +22°C and from day 2 on at +4°C.Supported by a grant from the Sigrid Jusélius Foundation, Helsinki, Finland     

Adrenal gland hematomas in trauma patients

PURPOSE: To evaluate the frequency of detection of trauma-induced adrenal gland hematoma in current practice by using computed tomography (CT) and to correlate presence of adrenal hematoma with quantitative clinical indicators of injury severity. MATERIALS AND METHODS: The radiology information system and the trauma registry were searched for cases of adrenal hematoma detected at trauma CT during a 54-month period. CT images depicting adrenal masses with the published characteristics of adrenal hematoma were reviewed by readers who were unblinded to the initial interpretations. Injury severity score (ISS), associated injury, and patient outcome data were gleaned from the trauma registry. The control group comprised patients entered in the trauma registry during the study period who did not have a diagnosis of adrenal hematoma. RESULTS: Fifty-four adrenal hematomas were detected in 51 patients: 42 with right-gland, 12 with left-gland, and three with bilateral lesions. The hematomas were round or ovoid and had a mean maximum diameter of 2.8 cm +/- 0.7 (SD) and a mean attenuation of 52 HU +/- 12. Periadrenal stranding was seen with 48 (89%) hematomas. At follow-up CT, 32 of 35 hematomas had resolved or decreased in size and attenuation. One patient with adrenal hematoma had no other intraabdominal injuries. Compared with the 6,757 control patients, the 51 patients with adrenal hematoma had a higher mortality rate (10% vs 4%; P <.001, chi(2) test) and a higher mean ISS (25.2 vs 9.7; P <.01, t test). Adrenal hematoma was found in 24 (0.4%) of 5,665 trauma patients with an ISS of 0-19, as compared with six (5.0%) of 122 patients with an ISS of 40 or higher. CONCLUSION: Adrenal hematoma was detected in 51 (1.9%) of 2,692 trauma patients who underwent CT, or 0.8% of all patients (n = 6,808) entered in the trauma registry. Compared with the other trauma patients, the patients with adrenal hematomas had severe injuries associated with higher mortality.     

小儿外伤性迟发性硬脑膜外血肿

目的 研究小儿外伤性迟发性硬脑膜外血肿的临床特点。并探讨其发生机制。方法 总结分析我科1991年1月-2001年10月收治的小儿外伤性迟发性硬脑膜外血肿23例。结果 本组手术清除血肿21例。血肿自行吸收2例。无死亡。结论 小儿迟发性外伤性硬脑膜外血肿多发生在伤后2-5d，占该类血肿78.3%，跌倒伤是主要的致伤原因，此类血肿可发生于颅内任何部位，但多伴有颅骨线形骨折。小儿外伤性迟发性硬脑膜外血肿及时发现和治疗，预后良好，CT扫描是可靠而简便的诊断方法，而延误诊断往往造成严重后果。     

Haemorrhage in intradiploic haemangioma mimicking extradural haematoma

Summary Traumatic haemorrhage in a previously occult intradiploic haemangioma in an elderly lady resulted in clinical and computer tomographic (CT) appearances mimicking an extradural haematoma. Literature relevant to this rare situation is briefly discussed.     

Scalp hematomas in children after hair braiding

We report two cases of scalp hematoma occurring in girls after the braiding of their hair. Subgaleal hematoma has been reported in children after relatively minor head trauma. We propose that the tension placed on the scalp during the placement of tight rows of hair braids is sufficient to result in such hematomas.     

Ultrasonographic examinations of muscle hematomas in hemophiliacs

Twenty-one ultrasonographic examinations were performed in 14 hemophiliacs with suspected intramuscular bleeding. In all patients who had an ultrasonographic examination within the first days after the onset of the symptoms, a hematoma was identified, and its resolution during transfusion therapy was possible to follow. In patients who had their first examination 3 to 5 weeks after the onset of symptoms and who had received transfusion therapy during this period, no hematoma was detectable. It is concluded that ultrasonography provides all necessary information needed for diagnosis and follow-up of treatment. Being a safe method, and giving no radiation, it should be the method of choice in the evaluation and follow-up of muscle hematomas in this patient group.     

慢性硬膜下血肿液纤维蛋白溶解特性

目的　探讨慢性硬膜下血肿 (CSDH)液中纤维蛋白溶解特征及其与再出血的关系。　方法　将 31例CSDH患者按照CT表现分为等、低、混合性和分层状密度 4类 ,采用电泳法和免疫染色法对血肿液中纤维蛋白原、纤维蛋白单体和D -二聚体进行测定。　结果　纤维蛋白原浓度在等密度血肿中为 (78± 14)mg L ,低密度中为 (14± 6 )mg L ,混合性密度中为 (16 0± 36 )mg L ,分层状密度中为 (15 9± 2 9)mg L ;纤维蛋白单体在 4类血肿中的浓度分别为 (780± 2 40 ) ,(180± 80 ) ,(182 0± 46 0 )和 (1840± 2 70 ) μg L ,D -二聚体的浓度分别为 (12 10± 186 ) ,(2 81± 15 2 ) ,(1139± 194)和 (196 2± 32 4)mg L。　结论　混合性和分层状CSDH腔内纤维蛋白溶解活性高 ,有较明显的再出血趋势。     

急性硬膜外血肿的救治

分析42例急性硬膜外血肿的救治，认为急性硬膜外血肿治疗应注重早期诊断，密切观察，及时抢救，对青壮年患者即使脑疝形成亦应及时手术清除血肿。