Unusual intradiploic hematoma

Abstract

This 58-year-old man presented with a left frontal bone lesion that had been growing over a 2-year period. The lesion increased in size, resulting in proptosis that affected the patient's visual acuity and eyeball movement. On computerized tomography and x-ray studies, a huge lesion located between the widened frontal diploic bone and involving the orbital roof and paranasal sinuses was noted. The entire lesion was radically resected. The authors unexpectedly found that an intradiploic organized hematoma had caused the swelling.

Chronic intradiploic hematoma in patients with coagulopathy

“…The specific source of the bleeding cannot be found in these cases. 2,3,7,8 Intradiploic hematomas cross the sutures unlike subperiosteal hematomas. 6 In a pediatric skull, micro movements at the sutural levels, which might be spontaneous or follow trivial trauma may lead to the formation of hematoma.…”

“…[3][4][5][6] Intradiploic hematomas can occur even in the absence of coagulation disorders. [7][8][9][10][11] It appears that intraosseous hematomas are not spontaneous in the true sense because the skull tables provide natural protection to the diploic space even in patients with coagulopathies. Trauma initiates bleeding into the diploic space.…”

“…1 The exact pathogenesis of intradiploic hematoma is unknown. [4][5][6][7] Chronic intradiploic hematomas have been reported with the use of anticoagulants, 8 birth trauma 3,6 and following shunt surgery. 9 Supplementary Table 1 shows the details of patients with intradiploic hematoma reported in the English literature.…”

Intradiploic hematoma of the frontal bone with secondary exophthalmos in a mare

“…The following list of differential diagnosis included primary neoplastic orbital disease (neuroendocrine tumor, extra‐adrenal paraganglioma, anaplastic sarcoma, squamous cell carcinoma, lymphosarcoma, malignant rhabdoid neoplasia, angiosarcoma, fibroma, melanoma) and non‐neoplastic disease (orbital cellulites, abscess, granuloma, hematoma, orbital fracture and dermoid cyst). Extension of extraorbital disease includes neoplasia of the paranasal sinuses (osteoma, adenocarcinoma, lymphosarcoma, squamous cell carcinoma) as well as non‐neoplastic disease (sinonasal cyst, hydatid cyst, chronic bacterial or fungal sinusitis, ethmoid hematoma, meningitis, masseter muscle myonecrosis) and expansile, intradiploic disease as intradiploic frontal bone mass (intradiploic hematoma, intradiploic epidermoid cyst, traumatic bone cyst, aneurysmal bone cyst, giant cell reparative granuloma, giant cell tumor and neoplasia) …”

“…Following radiography, the differential diagnoses included an expansile paranasal sinus cyst, hydatid cyst, chronic bacterial or fungal sinusitis of the frontal sinus, ethmoidal hematoma with unusual extension, expansile, intradiploic disease as intradiploic frontal bone mass (intradiploic hematoma, intradiploic epidermoid cyst, traumatic bone cyst, aneurysmal bone cyst, giant cell reparative granuloma, giant cell tumor and neoplasia) …”