The radiological demonstration of traumatic cysts due to severe soft tissue trauma

Treatment of late solidified hematoma in back donor site after breast reconstruction with latissimus dorsi flap: report of three cases

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.

Management of chronic expanding haematoma using triamcinolone after latissimus dorsi flap harvesting

Chronic expanding haematoma (CEH) is a rare type of haematoma that enlarges slowly and continuously without coagulation. It can occur following surgery because of shear stress-induced bleeding in the scar tissue between the subcutaneous fat and fascia. We present three cases of large chronic CEH that were successfully treated with triamcinolone injections. Three female patients developed large chronic CEH at 9 months, 5 years, and 6 years, respectively, after latissimus dorsi flap harvesting for breast reconstruction. Although the condition did not improve after multiple sessions of haematoma aspiration in the first two patients, it resolved following a single 40-mg triamcinolone injection along with appropriate compression dressing for several weeks. In the third patient, triamcinolone was injected immediately after the initial aspiration of the haematoma, and the condition improved considerably. There were no side effects in any of the patients. To the best of our knowledge, this is the first report of successful treatment of large CEH using triamcinolone. Therefore, we suggest that triamcinolone injections be considered for the treatment of CEH.

Giant post-traumatic cyst after motorcycle injury: a case report with review of the pathogenesis

Post-traumatic cysts of soft tissue usually occur at the junction of the subcutaneous fat and deep fascia, most often filled with serosanguinous fluid and lined with fibrous tissue. It appears as complication after severe injuries when crushing and shearing forces cause separation of the skin and subcutaneous fat from the deep fascia and muscle, creating a cavity filled with hematoma and liquefied fat. This rare condition calls Morel-Lavallee lesion, which was first described by this French physician in 1853 (Sterling et al., 1977; Tull and Borrelli, 2003). Magnetic resonance imaging is the modality of choice for detection and revealing the exact size and location of these lesions. The best method of treatment is surgical excision with complete resection.

Chronic expanding hematoma might be a potential insidious challenge for orthopedic surgeon

Chronic expanding hematomas can cause alarm both to the physician and to the patient because they simulate the growth of a malignant tumor. It is not always possible to bring back the cause to a specific traumatic event that the patient can remember. At this purpose, it is important to have a precise diagnosis when dealing with a growing mass and to exclude any malignancy before processing any treatment. In this article, we report the case of a young patient admitted to our department with a suspected soft tissue sarcoma, but imaging study and histological examination revealed to be hematoma. The authors want to emphasize the necessity of performing a complete clinical and instrumental study when surgeon has to deal with a growing mass. From accurate analysis of imaging, it is often possible to discriminate between malignancy and other benign forms.

The diagnosis and management of an expanding post-traumatic soft tissue cyst of the hip and groin

A post-traumatic cyst is a rare complication of significant soft tissue trauma. It occurs at the junction between the subcutaneous fat and underlying fascia, when a large, subcutaneous haematoma fails to resolve, developing into a chronic, fluid-filled cyst, lined with fibrous tissue. This results in a swelling that persists for years, gradually increasing in size, often without causing significant discomfort to the patient. Clinically and radiologically these swellings may be mistaken for neoplastic lesions. They can be difficult to treat, are refractory to conservative management and have a high rate of recurrence following surgical excision. Careful monitoring and early treatment of persistent postoperative seroma is advocated.

Spontaneous giant expanding thigh hematoma mimicking soft tissue neoplasm

We present a case of giant chronic expanding hematoma occurring in the left lateral thigh without any history of trauma or chronic medical disease. In our case, a diagnosis was unable to perform through conventional diagnosis method, which was confirmed by histopathological examination after successful surgical treatment. We suggest that patients who present with slowly growing extremity masses without trauma, in addition to soft tissue sarcoma and malignancy, chronic expanding hematoma should be considered in the differential diagnosis.

Long-standing Morel-Lavallée lesion of the thigh simulating a neoplasm

We report on the case of a 56-year-old man in whom a Morel-Lavallée lesion developed in the thigh. Ultrasound revealed a well-defined thick-walled cystic mass between the hypodermis and fascial planes that in some areas constituted hyperechoic papillar extensions in its wall. Magnetic resonance T(1)-weighted images showed that the mass was well circumscribed and mildly inhomogeneous and had a high signal intensity. On T(2)-weighted images, the mass had mixed signal intensity and a fluid-fluid level. We also discuss both the difficulty in making a differential diagnosis for and the treatment of this lesion.

A case of chronic expanding haematoma on the finger

We describe a patient with a chronic expanding haematoma developing in the right middle finger. Preoperative ultrasonography showed a cystic-like lesion upon the digital flexor tendon. Pathologic examination revealed a chronic organising haematoma surrounded by fibrous granulation tissue. Neither endothelial nor neoplastic cells were identified. We diagnosed this lesion as a chronic expanding haematoma (CEH) based upon the clinical course and pathological findings. The cause of our case was hypothesised to be repeated strain from the handle of heavy bag.

Chronic expanding hematoma in the psoas muscle

We report an unusual case of chronic expanding hematoma in the psoas muscle. A 53-year-old man was admitted for evaluation of a mass shadow in the left lower lung field on chest X-rays. He had also been suffering from dull left back pain. A computed tomography scan showed a cystic lesion with a rim enhancement in the left retroperitoneal space. Mixed signal intensity in a mosaic pattern was seen on a T2-weighted magnetic resonance image. We could not rule out a suspicion of a neoplastic intratumoral hemorrhage. Due to increased pain and the definite diagnosis, surgery was performed. Histopathological examination confirmed the diagnosis of chronic expanding hematoma. The expansion process is thought to be due to the irritant effects of blood and its breakdown products, which cause repeated exudation and bleeding from capillaries in the granulation tissues.

Enlarging intramuscular hematoma and fibrinolytic parameters

We describe eight patients with enlarging intramuscular hematoma who had no history of a bleeding tendency or trauma, other than for trivial incidental events of daily life. The hematoma gradually enlarged over 5-42 days and then diminished or disappeared within 3-5 months. This type of hematoma differs from both typical acute and chronic hematomas which were previously reported as a pseudotumor or a chronic expanding hematoma. The most important clinical task is to differentiate it from a malignant soft tissue tumor. A course in which the mass shrinks or disappears clinically, confirmed by magnetic resonance imaging findings, suggests the diagnosis. Laboratory tests, the bleeding time, and the blood coagulation time were normal in all patients, but the factor XIII concentration was slightly decreased. Depressed factor XIII concentrations may be an important etiologic factor in the genesis of this hematoma.

Papillary endothelial hyperplasia presenting as a chest wall neoplasm

Soft tissue hematomas generally resolve but may persist and develop into slow-growing, organized masses. These chronic expanding hematomas are characterized by a pseudocapsule and a predominantly necrotic central cavity, with foci of newly formed capillaries. These have been called chronic expanding hematomas or Masson's papillary endothelial hyperplasia. These lesions can mimic vascular neoplasms and must be considered in the evaluation of expanding soft tissue vascular malformations.