Chronic hematoma on the forearm mimicking soft tissue sarcoma

Abstract

Chronically expanding hematoma is a rare entity, characterized by its persistence and increasing size. Chronic hematoma may be misdiagnosed as a soft tissue neoplasm due to its large size and slow progression and enlargement. A 77-year-old man presented with a large, protuberant mass in the anterior left forearm. There was no clear history of trauma, bleeding disorder, or coumadin or anti-platelet medication. This case had initially been considered to be a soft tissue sarcoma, determined by means of clinical and radiological examinations. An incisional biopsy was found to be insufficient for a histopathological diagnosis. Hematoma was also found taking over the arteria brachialis, so it was excised with arterial resection. In order to rescue the circulation of the hand, an anastomosis was performed between the brachial and radial arteries with a graft from the saphenous vein. To differentiate the diagnosis of expanding hematoma from sarcoma can be very difficult, either clinically or radiologically. Incisional biopsies taken from the necrotic tissues or hemartoma do not always reveal tumoral cells. In order to attain a correct diagnosis, a surgical procedure should be performed in an operating room under the supervision of an anesthesiologist.