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Von Stauffenberg F, Hegemann I, Schwotzer R, Lehmann K, Widmer J. Management of abdominal pseudotumours in haemophilia: a systematic review. Swiss Med Wkly 2023; 153:40094. [PMID: 37598304 DOI: 10.57187/smw.2023.40094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/21/2023] Open
Abstract
AIM Haemophilic pseudotumours are complications in patients with haemophilia A or B and result from locally repetitive bleeding, mainly in the musculoskeletal system. Abdominal haemophilic pseudotumours are exceptionally rare but may cause severe complications. This systematic review aimed to evaluate therapy strategies for symptomatic abdominal haemophilic pseudotumours. METHODS We systematically searched three databases (Medline [PubMed], Web of Science and EMBASE) for publications published between 1995 and 2023. Two reviewers independently selected the studies, extracted data and performed a quality assessment using the JBI critical appraisal checklist. RESULTS From a total of 1199 articles, 39 articles describing 41 cases were included for final analysis. Conservative or interventional treatment was performed in 12 cases. In eight cases, a step-up to surgical therapy after interventional treatment was indicated. Primary surgical therapy was performed in 21 cases. Failure to cure was documented in 50% (n = 6) of patients treated in the first group, with a mortality rate of 16.6% (n = 2). Interventional therapy with a step-up to surgery showed no morbidity or mortality. Primary surgical resection documented favourable results in 66.6% (n = 14), with failure to cure in 9.5% (n = 2) and a mortality rate of 14.3% (n = 3). CONCLUSION Primary surgical resection can be a first-line therapy for symptomatic, abdominal haemophilic pseudotumours, whereas preoperative embolisation could be used as a bridging therapy before surgery, especially in emergency settings. Diagnostic biopsy and percutaneous drainage should be avoided to prevent complications.
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Affiliation(s)
- Franz Von Stauffenberg
- Department of Surgery and Transplantation, Zurich University Hospital, Zurich, Switzerland
| | - Inga Hegemann
- Department of Medical Oncology and Hematology, Hemophilia Comprehensive Care Center, Zurich University Hospital, Zurich, Switzerland
| | - Rahel Schwotzer
- Department of Medical Oncology and Hematology, Hemophilia Comprehensive Care Center, Zurich University Hospital, Zurich, Switzerland
| | - Kuno Lehmann
- Department of Surgery and Transplantation, Zurich University Hospital, Zurich, Switzerland
| | - Jeannette Widmer
- Department of Surgery and Transplantation, Zurich University Hospital, Zurich, Switzerland
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Yao YF, Gao Q, Li JL, Xue CX, Fang W, Jing JH. Outcome of Surgical Management of Hemophilic Pseudotumor: Review of 10 Cases from Single-Center. Orthop Surg 2021; 14:27-34. [PMID: 34841675 PMCID: PMC8755878 DOI: 10.1111/os.13174] [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: 02/02/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the operative methods and clinical results of surgical treatment in a case series of 10 patients with hemophilic pseudotumors. Methods Ten patients with hemophilic pseudotumors who received surgical resection treatment in our hospital from October 2017 to June 2020 were retrospectively reviewed. All patients were hemophilia A (factor VIII deficiency).The age range was 20–51 years. Preoperative imaging examination revealed the size of irregular mass from 8.2 cm× 3.3 cm× 2.3 cm to 22.3 cm× 15.5 cm× 17.0 cm. With the supplementary of recombinant coagulation factor VIII, five cases received complete resection; one received resection and skin grafting; one received cytoreduction surgery as the pseudotumor closing to iliac vessel and nerve; three cases received complete resection and construction as bone destruction. The perioperative variables were recorded and all the patients were followed in the outpatient clinic. Clinical and radiological assessments were conducted. Results In these patients, the average intraoperative blood loss volume was 783.1 mL (range, 240–2100 mL). Six patients received blood transfusion during perioperative period. The average duration of surgery was 140.7 min (range, 110–240 min). All wounds healed smoothly and there was no infection or chronic sinus formation. The average length of hospital stay was 16.3 days (range, 12–25 days). There is no iatrogenic vascular nerve injury in our series. Complete follow‐up was performed in all patients. Mean follow‐up duration was 14.2 months (range, 6–26 months). One patient with pseudotumor in the thigh had a recurrence 1 year after operation, then secondary operation was performed. In three cases who received complete resection and construction, patient 8 obtained bone graft and late fixation. X‐ray examination showed bone formation in the lesion at the 2‐year follow‐ups after operation. Patient 9 underwent knee replacement, his left knee showed flexion deformity in preoparation. At the last follow‐up, range of motion was improved from 0° to 40° compared with preoperative status. Patient 10 had pseudotumor in the distal femur, received long bone graft and intramedullary nail fixation. Conclusions Surgical resection for hemophilic pseudotumors is an effective and safe method. The choice of surgical procedure must be individualized according to the localization and progress of pseudotumor.
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Affiliation(s)
- Yun-Feng Yao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Qiang Gao
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Jia-le Li
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Chen-Xi Xue
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Wang Fang
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
| | - Jue-Hua Jing
- Department of Orthopaedic Surgery, Second Affiliated Hospital of Anhui Medical University, Heifei, China
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Pasta G, Ruggieri R, Annunziata S, Gallese A, Gagliardi VP, Cuzzocrea F, Ghiara M, Russo M, Preti PS, Santi RM, Mosconi M, Benazzo F. Haemophilic Pelvic Pseudotumour: A New Surgical Option. Healthcare (Basel) 2021; 9:1269. [PMID: 34682949 DOI: 10.3390/healthcare9101269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/08/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 12/02/2022] Open
Abstract
Background: Haemophilia is an inherited coagulopathy caused by the absence or dysfunction of clotting factor VIII or IX. Clinical manifestations are generally secondary to recurrent bleeding episodes mainly in the musculoskeletal system. Bleeding symptoms appear early in life and, when the disease is severe (when plasma factor VIII or IX activity is <1% of normal), joint and muscle bleeding may occur spontaneously. A pseudotumour is a recurrent, chronic, encapsulated, slowly expanding, muscle hematoma. Haemophilic pseudotumour is a rare complication of haemophilia which occurs, as a condition either from repeated spontaneous bleeding or coming from a traumatic origin, in 1–2% of haemophilic patients. Case report: A 32-year-old man with severe haemophilia A referred to our Clinic with a massive right iliac wing pseudotumour complicated by Staphylococcus aureus superinfection and skin fistulisation. In this report we describe the medical management and surgical treatment by the adoption of a novel surgical technique which involves the use of a pedicle-screw and rod system (PSRS), a polyglycolic acid MESH and bone cement in order to build up an artificial ilium-like bony mass. This case report highlights the importance of interdisciplinary approach and the efficacy of eradicating surgery as treatment, especially in the case of large and long-lasting lesions.
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Rodriguez-Merchan EC. Complications of Muscle Hematomas in Hemophilia. Cardiovasc Hematol Disord Drug Targets 2021; 20:242-248. [PMID: 32294050 DOI: 10.2174/1871529x20666200415121409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 11/15/2019] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/22/2022]
Abstract
Prevention is essential for avoiding the complications of muscle hematomas (compartment syndrome, pseudotumors and peripheral nerve lesions) in hemophilic patients. This is achieved through early diagnosis of muscle hematomas and proper long-term hematological treatment until they have resolved (confirmed by image studies). Ultrasound-guided percutaneous drainage could be beneficial in terms of achieving better and faster symptom relief. Acute compartment syndrome (ACS) requires emergency surgical treatment (decompression fasciotomy). As for pseudotumors, the biopsy will help us confirm the diagnosis and rule out true tumors (chondrosarcoma, liposarcoma, synovial sarcoma) that sometimes mimic hemophilic pseudotumors. Surgical removal of hemophilic pseudotumors is the best solution. As alternatives, there are curettage and filling with cancellous bone and radiotherapy (when surgery is contraindicated). Preoperative arterial embolization (ideally 2 weeks before surgery) helps control intraoperative bleeding during surgery for giant pelvic pseudotumors. Peripheral nerve injuries, which are rare, almost always occur due to compression of hematomas in the vicinity. In most cases, they usually resolve with hematological treatment only. If such treatment fails, surgery would be indicated.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopaedic Surgery, La Paz University Hospital-IdiPaz, Paseo de la Castellana 261, 28046-Madrid, Spain
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Chatterjee S, Mukhopadhyay R. Intra-Abdominal Mesenteric Haemophilic Pseudotumour in an Undiagnosed Case of Haemophilia: a Rare Cause of Intestinal Obstruction. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bian YY, Wu H, Huang Z, Zhai J, Liu Y, Weng XS. Surgical treatment of a giant iliopsoas haemophilic pseudotumour with adjacent structure compressions: A case report. Haemophilia 2017; 23:e507-e512. [PMID: 28869681 DOI: 10.1111/hae.13299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Y Y Bian
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - H Wu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Z Huang
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - J Zhai
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - Y Liu
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Beijing, China
| | - X S Weng
- Department of Orthopaedic Surgery, Peking Union Medical College Hospital, Beijing, China
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Pennekamp PH, Strauss AC, Klein C, Marx A, Goldmann G, Friedrich M, Marquardt N, Oldenburg J. Giant haemophilic pseudotumour of the pelvis: case report and literature review. Haemophilia 2015; 21:e484-6. [DOI: 10.1111/hae.12752] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2015] [Indexed: 11/30/2022]
Affiliation(s)
- P. H. Pennekamp
- Department of Orthopaedics and Trauma Surgery; University of Bonn; Bonn Germany
| | - A. C. Strauss
- Department of Orthopaedics and Trauma Surgery; University of Bonn; Bonn Germany
| | - C. Klein
- Institute of Experimental Haematology and Transfusion Medicine; University of Bonn; Bonn Germany
| | - A. Marx
- Internal Medical Clinic I; University of Bonn; Bonn Germany
| | - G. Goldmann
- Institute of Experimental Haematology and Transfusion Medicine; University of Bonn; Bonn Germany
| | - M. Friedrich
- Department of Orthopaedics and Trauma Surgery; University of Bonn; Bonn Germany
| | - N. Marquardt
- Institute of Experimental Haematology and Transfusion Medicine; University of Bonn; Bonn Germany
| | - J. Oldenburg
- Institute of Experimental Haematology and Transfusion Medicine; University of Bonn; Bonn Germany
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López-Gómez J, Contreras JS, Figueroa-Ruiz M, Servín-Torres E, Velázquez-García J, Bevia-Pérez F, Delgadillo-Teyer G. Management of the hemophilic pseudotumor of the abdomen: A rare pathological entity. Int J Surg Case Rep 2014; 5:789-92. [PMID: 25290383 PMCID: PMC4245669 DOI: 10.1016/j.ijscr.2014.08.022] [Citation(s) in RCA: 10] [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: 02/18/2014] [Revised: 07/16/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Hemophilic pseudotumor is a rare complication that occurs in patients with severe hemophilia. Results from multiple episodes of bleeding into the bones and soft tissues. PRESENTATION OF CASE A 31 years old male patient, with severe hemophilia A. Diagnosed with an abdominal tumor 10 years ago during routine screening, that progressively grew to encompass the entire abdominal area, with symptoms of intestinal obstruction. DISCUSSION Hemophilic pseudotumor appears as a painless tumor of slow growth that can compress vital organs producing bone destruction, muscle and skin necrosis. The tumor may have fistulas or break spontaneously. CONCLUSION The abdominal hemophilic pseudotumor is a rare pathological entity, with few reports worldwide, but must be considered in hemophilic patients with a well documented abdominal tumor.
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Affiliation(s)
- Javier López-Gómez
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico.
| | - Juan S Contreras
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Marco Figueroa-Ruiz
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Erick Servín-Torres
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - José Velázquez-García
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Francisco Bevia-Pérez
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
| | - Germán Delgadillo-Teyer
- Instituto Mexicano Del Seguro Social, Department of General Surgery, Hospital de Especialidades Centro Médico Nacional La Raza, Seris y Zaachila SN, Col. La Raza, CP 02990 México, D.F., Mexico
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Murai A, Sugiu K, Kariya S, Nishizaki K. Transcatheter arterial embolisation for paediatric inflammatory pseudotumour of the maxillary sinus. J Laryngol Otol 2011; 125:1189-92. [PMID: 21810292 DOI: 10.1017/S0022215111001848] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Inflammatory pseudotumours are mostly seen in the lung, and occasionally in the head and neck region including the sinonasal area. Reported treatment modalities comprise corticosteroid treatment, surgical excision and radiotherapy. The latter option is required because wide surgical resection may be difficult for head and neck lesions, especially in children. However, clinicians should be aware of the risk of late-onset side effects of radiotherapy in children. CASE REPORT We present a two-year-old girl with a massive inflammatory pseudotumour of the maxillary sinus. Transcatheter arterial embolisation was performed, and the lesion was successfully managed without additional therapy. There was no evidence of recurrence over the next five years. CONCLUSION This is the first report presenting the utility of arterial embolisation for inflammatory pseudotumour.
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Kumar R, Pruthi RK, Kobrinsky N, Shaughnessy WJ, McKusick MA, Rodriguez V. Pelvic pseudotumor and pseudoaneurysm in a pediatric patient with moderate hemophilia B: successful management with arterial embolization and surgical excision. Pediatr Blood Cancer 2011; 56:484-7. [PMID: 21105052 DOI: 10.1002/pbc.22678] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Development of pseudotumors is an unusual complication of hemophilia. Treatment is controversial, especially in patients with large proximal lesions. Surgery, while curative, can be associated with massive intra-operative bleeding, infection and amputation. Arterial embolization of blood vessels supplying the pseudotumor may reduce these complications. Herein, we report a 14-year-old patient with moderate hemophilia B with a pelvic pseudotumor and pseudoaneurysm that failed conservative management with factor replacement alone. He was successfully treated with Bead Block and coil embolization followed by surgical extirpation of the lesion 24 hr later.
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Affiliation(s)
- Riten Kumar
- Division of Pediatric Hematology/ Oncology, Mayo Clinic, Rochester, Minnesota 55905, USA
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RODRIGUEZ-MERCHAN EC, JIMENEZ-YUSTE V. The role of selective angiographic embolization of the musculo-skeletal system in haemophilia. Haemophilia 2009; 15:864-8. [DOI: 10.1111/j.1365-2516.2009.02015.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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ESPANDAR R, HEIDARI P, RODRIGUEZ-MERCHAN EC. Management of haemophilic pseudotumours with special emphasis on radiotherapy and arterial embolization. Haemophilia 2009; 15:448-57. [DOI: 10.1111/j.1365-2516.2008.01942.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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KLAMROTH R, GOTTSTEIN S, ESSERS E, LANDGRAF H, WILASCHEK M, OLDENBURG J. Successful angiographic embolization of recurrent elbow and knee joint bleeds in seven patients with severe haemophilia. Haemophilia 2009; 15:247-52. [DOI: 10.1111/j.1365-2516.2008.01842.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McDonald EJ, Corbett R, Smith MP. Successful management of a distal haemophilia pseudotumour: case illustration and literature review. Haemophilia 2008; 14:987-8. [PMID: 18637843 DOI: 10.1111/j.1365-2516.2008.01819.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E J McDonald
- Canterbury Health Laboratories, Christchurch, New Zealand.
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Bibliography. Current world literature. Hematology and oncology. Curr Opin Pediatr 2008; 20:107-13. [PMID: 18197049 DOI: 10.1097/MOP.0b013e3282f572b6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Abstract
Hemophilic pseudotumor is an uncommon complication seen in approximately 1-2% of patients with severe hemophilia. Hemophilic pseudotumors are distinguished into two subdivisions based on location, proximal or distal. Plain x-rays and CT are useful in diagnosis, but MR imaging is the diagnostic test of choice because of its sensitivity to the various blood products. The choice of therapy depends on many parameters, such as the size of the tumor, the age of the patient, and the relation with underlying organs. In most cases of asymptomatic hemophilic pseudotumor, conservative treatment with administration of missing factor as well as immobilization is recommended. The authors describe a 13-year-old boy with severe hemophilia A, who presented with a tibial pseudotumor a few months after an injury. He was conservatively treated for a long period, with daily administration of recombinant factor VIII. His clinical condition improved shortly after therapy induction, but radiological improvement has been moderate. Case history, imaging findings, and therapeutic options are discussed.
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Affiliation(s)
- Emmanouil S Hatzipantelis
- Hippokration General Hospital of Thessaloniki, 1st Paediatric Department of Aristotle University of Thessaloniki, Thessaloniki, Greece.
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