Chronic expanding hematoma in the chest

Radiological features of intrathoracic chronic expanding hematoma: A case report

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.

Chronic expanding hematoma in the liver: a case report

Background

A hematoma that gradually increases over a chronic course of months or longer is defined as a chronic expanding hematoma (CEH). CEHs often develop in the limbs and on body surfaces that are susceptible to external stimuli. CEHs in the intrathoracic or intraperitoneal organs are uncommon, with liver CEHs being particularly rare worldwide.

Case presentation

A 57-year-old woman was previously diagnosed with a giant cyst in the right liver lobe, with a longer axis of approximately 15 cm. Abdominal ultrasonography findings suggested a complex cyst, and she was referred to our hospital for further inspection. Although CEH was suspected, it was difficult to exclude malignant diseases such as intraductal papillary neoplasm of the bile duct and cystadenocarcinoma. There was a possibility of malignant disease and the exclusion of surrounding organs due to tumor growth. Therefore, a right hepatectomy was performed. Pathological examination revealed a pseudocyst containing a clot, which was consistent with CEH.

Conclusions

CEH rarely occurs in the liver; however, it is necessary to consider CEH when a slow-growing hepatic mass that shows a mosaic pattern on magnetic resonance imaging is found.

Chronic expanding hematoma in the chest: A case report

Chronic expanding hematoma (CEH) is a rare disease that is usually present as a large solitary pulmonary nodule. CEHs are slow growing, but processes underlying their development remain unknown. The present study herein reports the case of a 76-year-old male patient with CEH and discusses a number of CEH cases published in the literature. The majority of these previously described patients were Asians. The CEH in the present case was not a successfully resected one, but the patient's clinical course provided information concerning the natural history of the disease. During the clinical course, the patient underwent several chest computed tomography scans. For the present case report, the doubling time and volume change of the mass was calculated, which revealed that the lesion had an inconstant growth rate and that its onset was between 8.2-11.0 years before the patient succumbed to this disease. Accumulation of knowledge about this rare disease will help to elucidate it further.

Chronic expanding hematoma: a late complication 45 years after thoracoplasty

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.

Giant chronic expanding hematoma in the chest identified 25 years after a blunt chest trauma

We herein report the case of a 42-year-old man who presented with a huge intrathoracic mass that had grown over a period of 25 years. The initial symptom caused by the mass was dull pain in the chest. T2-weighted magnetic resonance imaging revealed a mosaic pattern of various signal intensities, indicating a chronic expanding hematoma. The mass was completely resected surgically. For patients who present with a slowly growing mass, particularly those with a history of tuberculous pleuritis, chest surgery or trauma, a chronic expanding hematoma should be taken into consideration. Surgical resection is the first choice of treatment for a chronic expanding hematoma caused by a blunt chest trauma.

Chronic expanding hematoma with a significantly high fluorodeoxyglucose uptake on ¹⁸F-fluorodeoxyglucose positron emission tomography, mimicking a malignant soft tissue tumor: a case report

Introduction

Chronic expanding hematoma is a rare persistent hematoma that can sometimes be misdiagnosed as a malignant tumor due to its clinical and radiological features.

Case presentation

A 42-year-old Japanese man with a large mass in his leg, suggestive of malignancy, presented to our hospital. He had been aware of the leg swelling for the last eight years. A magnetic resonance imaging scan demonstrated a large mass with two components. One was a large, well-defined cystic mass (13×9cm) showing high intensity on T1- and T2-weighted images, and the other was a solid mass (3.5×2.5cm, adjacent to the large mass) with high intensity on T1-weighted images. Two-[¹⁸F]fluoro-2 deoxy-D glucose positron emission tomography images revealed increased uptake with a maximum standardized uptake value of 15.8 in the solid mass. As these findings were considered suggestive of hematoma associated with a malignant lesion, an open biopsy was performed. A pathological examination demonstrated a hematoma with xanthogranuloma, and no malignant cells were evident. Therefore, we resected the tumor including both components, and the histological diagnosis was chronic expanding hematoma. Clinical diagnosis based on 2-[¹⁸F]fluoro-2 deoxy-D glucose uptake is sometimes limited by the fact that 2-[¹⁸F]fluoro-2 deoxy-D glucose is taken up by not only malignant tumor cells but also macrophages and tissues with granulation or inflammation.

Conclusions

Significantly increased standardized uptake value in the peripheral rim of the lesion on 2-[¹⁸F]fluoro-2 deoxy-D glucose positron emission tomography imaging, mimicking a soft tissue sarcoma, should be recognized as a potential diagnostic pitfall in cases of chronic expanding hematoma.

Chronic tension empyema

A 60-year-old man who had suffered from chronic left tuberculous empyema for 25 years, was diagnosed with chronic tension empyema based on enlargement of the empyema cavity. To prevent compression of the heart and left lung, we removed the empyema capsule. This procedure relieved the compression of the left lung, and the patient's lung function improved.

Treatment strategies for chronic expanding hematomas of the thorax

PURPOSE

To investigate retrospectively the treatment strategies for chronic expanding hematoma (CEH) of the thorax.

METHODS

We reviewed the medical records of six patients treated for CEH of the thorax at our institution between October 1996 and October 2006.

RESULTS

All of the patients had a history of thoracic surgery or tuberculosis with a latent period of 12-55 years before onset. One elderly patient with ischemic heart disease and in poor general health demonstrated a substantial improvement of symptoms after undergoing arterial embolization twice instead of surgery. The remaining five patients underwent either pleuropneumonectomy or a total capsule excision, following which their clinical condition improved remarkably. All six patients were discharged from the hospital. Arterial embolization was performed before surgery, and the amount of intraoperative bleeding ranged from 905 ml to 6,590 ml (average: 2,396 ml).

CONCLUSION

Chronic expanding hematoma of the thorax may occur after thoracic surgery and a tuberculosis infection; however, considering the risk of massive bleeding during surgery, the decision to perform surgery should be made with extreme care.

Use of contrast-enhanced computed tomography for management of a late-onset spontaneous massive chest wall hematoma

This is a rare case of a 68-year-old woman who was rehospitalized after uneventful redo double-valve surgery. An 8.3 × 12.9 × 16.4 cm tense right chest wall hematoma was diagnosed. This was precipitated by a single cough. Contrast-enhanced computed tomography revealed a bleeding source. Hematoma evacuation and hemostasis following emergency warfarin reversal produced an excellent outcome.

Extrathoracic protrusion of a chronic expanding hematoma in the chest mimicking a soft tissue tumor

We report an uncommon clinical case of extrathoracic protrusion of a chronic expanding hematoma in the chest, mimicking a soft tissue sarcoma. A 77-year-old Japanese man was successfully treated by chest wall resection and partial decortication of the lung. The postoperative pathology examination confirmed a diagnosis of a granular cell reaction. Details of the clinical and radiographic features are presented.

Chronic expanding hematoma in the chest

Chronic expanding hematoma in the chest is identified as a specific type of chronic empyema. We encountered a case of chest chronic expanding hematoma presenting as a huge mass, which compressed the heart, trachea and esophagus. The disease was recognized as a cause of aspiration pneumonia and was successfully treated by surgical resection. Computed tomography revealed a large area of calcifications at the periphery of the mass. Magnetic resonance T2-weighted imaging indicated the mosaic patterns of various signal intensities as specific features of chronic expanding hematoma. Imaging diagnosis showed good correlation with pathology of the disease.

Chronic expanding hematoma of the thorax

We report the first case in Korea of a chronic expanding hematoma, which presented as a huge mass in the pleural cavity. A 67-year-old woman exhibiting a slowly-expanding intrathoracic mass, as revealed by a chest radiograph, was admitted to our hospital. The patient had undergone a pneumonectomy 37 years earlier during treatment for pulmonary tuberculosis. Computed tomography revealed a huge mass in her right hemithorax. The differential diagnosis of this mass included chronic empyema combined with a malignancy, such as lymphoma or a soft tissue sarcoma. The tumor, which was classified as an encapsulated chronic hematoma, was removed surgically. Samples sent for histopathological and microbiological analysis revealed no evidence of neoplasia or infection. The patient was finally diagnosed with a chronic expanding hematoma of the thorax. This case is particularly rare due to the patient's development of a very large mass after undergoing treatment for tuberculosis more than 30 years earlier.

Perirenal expanding haematoma in a cat

A four-year-old, entire male domestic cat was referred for assessment of a large abdominal mass of three-weeks duration. Diagnostic imaging suggested the presence of either splenic neoplasia, an abdominal abscess or haematoma. A coeliotomy was performed and an enlarged, irregular mass, including the left kidney and adrenal gland, was identified. The mass was removed, requiring a left adrenalo-uretero-nephrectomy. The aorta was accidentally punctured during the procedure, resulting in paraplegia. Given a poor prognosis, the owners decided to have the cat euthanased. Histological examination of the mass was characteristic of a chronic expanding haematoma.

Expanding hematoma after extraperiosteal paraffin plombage

PURPOSE

The development of a chronic expanding hematoma after paraffin plombage has not yet been reported because the procedure was performed only at a limited number of institutes during the short period before the development of antituberculous drugs. We herein report eight patients with chronic expanding hematoma several decades after undergoing extraperiosteal paraffin plombage.

METHODS

We reviewed eight surgically treated patients with chronic expanding hematoma after undergoing extraperiosteal paraffin plombage.

RESULTS

Swelling of the plombage space was shown in a chest roentgenogarm and a contrast-enhanced computed tomographic scan as an expanding inhomogeneous mass with subcapsular enhancements. The patient symptoms included a chest or axillary tumor in three patients, and shoulder pain in two, while three were asymptomatic prior to radiological evidence of disease progression. No tuberculous bacillus was detected on microbacterial examination. Both the paraffin and hematomas were removed. The average operative bleeding was 161 ml. One patient underwent muscle transposition for postoperative infection of the residual space. Following the operation, seven patients remained free from the disease and one had hematoma recurrence 9 years later, which was again removed.

CONCLUSION

A chronic expanding hematoma following extraperiosteal paraffin plombage is a rare complication. However, this disease should be considered when a patient who has undergone paraffin plombage presents with late complications.

Chronic expanding hematoma of the thigh simulating neoplasm on gadolinium-enhanced MRI

Patients who present with slowly growing extremity masses are often imaged with MRI to be examined for possible tumors. In addition to cysts and neoplasms, chronic expanding hematomas should be considered in the differential diagnosis if the patient has a history of remote trauma. The presence or absence of internal contrast enhancement is often used to distinguish between hematomas and hemorrhagic neoplasms on MRI and CT. We present the unusual case of a patient who had a chronic expanding hematoma of the calf that demonstrated nodular internal enhancement on gadolinium-enhanced MRI, simulating a neoplasm.

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 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.

Cervical expanding hematomas in dogs: five cases

Five puppies were presented to the Alfort National Veterinary School for a rapidly expanding, well-demarcated, subcutaneous cervical mass of a few days' duration. In all cases, previous trauma was reported. Fine-needle aspiration of the mass in each case revealed a serosanguineous fluid containing mainly erythrocytes, with a total protein concentration ranging from 3.5 to 5.2 g/dL. Coagulation tests failed to reveal any coagulation disorder. En-bloc surgical removal of the fluid-filled mass associated with short-term postoperative drainage was curative in all cases. Histopathological examination of the mass revealed encapsulated hematoma. The disease resembles chronic expanding hematoma in humans.