Chronic Expanding Hematoma in the Extremities: A Clinical Problem of Adhesion to the Surrounding Tissues

Abstract

Chronic expanding hematoma is characterized by continuous growth of a blood collection. We analyzed the clinical features of 7 patients with chronic expanding hematomas in the extremities, with an average age of 65.6 years. All lesions occurred in the lower extremities, with 4 seen in the thigh and 3 in the knee region. Six patients had subcutaneous hematomas, while 1 was deep-seated in the thigh. The magnetic resonance features of the lesion were compatible with those of a standard hematoma. A low signal intensity on T1- and T2-weighted imaging at the pseudocapsule was also characteristic. Cystic features were seen in 5 of 7 patients. All lesions were resected together with their pseudocapsule. In the subcutaneous lesions, it was necessary to resect adherent fascia, with or without involved skin. In the deep-seated thigh lesion, the common peroneal nerve was completely adherent to the pseudocapsule, a phenomenon from absence of the common peroneal nerve which appeared after resection. Chronic expanding hematomas of the extremities are predominantly located in the subcutaneous tissue of the lower extremity. The surrounding pseudocapsule is adherent to the adjacent tissues, and clinicians must be aware of this, especially when resecting a deep-seated lesion.

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“…Symptoms of hematoma depend on their location and whether adjacent structures are affected by in ammation and swelling associated with bleeding, which may include headache, dizziness, reduced range of motion, and in ammation symptoms (18). Hematomas are usually absorbed gradually and decrease in size, except in rare cases where their size slowly increases, which is called chronic expanded hematoma (19,20). Hematoma can also cause irritation and in ammation.…”

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“…Adhesion of soft tissue by surrounding hematoma has been previously reported [16][17][18]. Hematoma is composed of various cellular, molecular, and induced growth factors, as well as inflammatory cytokines [19].…”

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“…However, complete removal is reportedly difficult in patients with thoracic lesions due to abundant neovascularization beneath the pseudocapsule and the presence of fibrous adhesions to the chest wall [11]. Resection of deep lesions in the extremities is problematic due to adhesion to surrounding tissue [3]. Partial resection of the cyst wall of chronic expanding hematoma, with the portion of the cyst that adheres to surrounding tissue left behind, may be adequate as treatment [5,12].…”

“…Chronic expanding hematoma of the limb that is associated with adhesion to surrounding tissue is clinically problematic [3]. An association between chronic expanding hematoma and trauma or surgery has been reported, with chronic expanding hematoma often being a late complication [4,5].…”