Huge chronic expanding hematoma of the iliac bone following multiple hip surgeries: a case report

Abstract

BackgroundChronic expanding hematoma is a rare entity resulting from trauma or surgery. This condition usually occurs in soft tissue, such as the trunk or extremities, while chronic expanding hematoma arising from bone has not been reported previously. We describe an unusual case of a huge intraosseous chronic expanding hematoma arising from the ilium, which had grown over a 40-year period following hip surgeries.Case presentationA 57-year-old Japanese woman presented with a 1.5-year history of right hip pain. She had a history of bilateral developmental dysplasia of the hip and had undergone bilateral arthroplasties in childhood. A physical examination revealed a large, firm, immobile mass at her right ilium. Based on radiographic findings, a type of slow-growing bone tumor was suspected, and an incisional biopsy was performed. A histopathologic examination revealed large amounts of old clotted blood within the lesion, and the capsule of the lesion was composed of dense, fibrous, connective tissue. There was no evidence of neoplasia, and chronic expanding hematoma was suspected. The lesion was resistant to conservative treatment, and so we performed an internal hemipelvectomy (including the capsule of the mass) and a reconstruction by hip transposition 2.5 years after the incisional biopsy. There was no recurrence of chronic expanding hematoma at the most recent follow-up of 1 year and 8 months postoperatively.ConclusionsA chronic expanding hematoma is characterized by its persistence and increasing size more than 1 month after the trauma or surgical event suspected of causing hemorrhage. To the best of our knowledge, this is the first report of chronic expanding hematoma arising from bone. We performed internal hemipelvectomy and hip transposition, and there has so far been no recurrence. This disease may be considered a differential diagnosis for bone tumor when the patient has a history of surgery or trauma, regardless of how many years have passed since the index event.

Large intraosseous chronic expanding hematoma after total hip arthroplasty presenting with chronic disseminated intravascular coagulation: a case report and literature review

“…This is the first reported case of a large intraosseous CEH that presented with chronic DIC and occurred 22 years after THA; it was successfully treated with a single-stage excision and revision THA. In 2018, Morishita et al [3] first reported a case of a rare complication wherein a CEH arose from the iliac bone following a hip surgery. To the best of our knowledge, this is the only other reported case of an intraosseous CEH.…”

Chronic expanding hematoma mimicking seroma, following a totally extraperitoneal approach for inguinal hernia: a case report

“…Certain stimuli, such as trauma and surgery, are related to the development of CEH [ 5 , 7 , 8 ]. In fact, some rare cases of surgery-related CEH have been reported [ 5 , 9 , 10 ]. Therefore, CEH can theoretically occur anywhere in the body.…”

Radiological features of intrathoracic chronic expanding hematoma: A case report

“…In rare cases, a hematoma may slowly increase in size after an initial hemorrhagic event, referred to as a chronic expanding hematoma ( CEH ) [ 1 ]. CEH can develop in any body region [ [2] , [3] , [4] ] and is often difficult to distinguish from malignant tumors because of its large size and slow progressive enlargement [ 5 ]. Herein, we present a relatively rare case of intrathoracic CEH after thoracic surgery for lung cancer more than 20 years prior and describe its radiological features in detail.…”