Chronic Hematoma Research Articles

Pleomorphic Sarcoma Mimicking a Chronic Hematoma, Ultimately Diagnosed by Angiography

Pleomorphic Sarcoma Mimicking a Chronic Hematoma, Ultimately Diagnosed by Angiography

The extrapleural fat sign on postmortem computed tomography may differentiate acute from chronic extrapleural hematomas

Extrapleural fat sign is currently regarded as a CT finding that is useful in detecting Extrapleural hematoma (EH). The EH is caused by bleeding between parietal pleura and fascia endothoracica. The incidence of EH is low and thus the opportunity to study EH with both postmortem computed tomography (PMCT) and autopsy remains rare. Here we report two autopsy cases of EH that were also studied with PMCT. Case 1, acute EH case, was 90-year-old male, knocked down by a car. Two days after, he died. On PMCT, clear extrapleural fat sign was found in EH. On autopsy, his EH was shown to be mainly made by fresh clot. Fracture of the ribs was found under the EH. Hematoxylin-eosin (HE)-stained section revealed vacuoles, implying the existence of fatty tissue, between EH and pleura. Case 2, chronic EH case, was 76-year-old male, found dead in bathtub. On PMCT, EH without extrapleural fat sign was demonstrated. On autopsy, EH made by organized clot, was found. HE stained sections revealed heavy proliferation of fibroblasts lacking vacuoles in this clot. Thus it seems likely that extrapleural fat sign on PMCT reflects the time elapse after EH formation: Fat layer is present in acute EH, causing fat sign on image. Then, the fat layer is replaced by fibroblasts along with the development of inflammation reaction, causing disappearance of fat sign. Thus, evaluation of fat sign may be used to know if the HE is acute or chronic in forensic medicine as well as in clinical medicine.

Idiopathic Intrasyringal Hemorrhage: A Case Report and Review of the Literature

Abstract INTRODUCTION Intrasyringal hemorrhages, also known as Gower's hemorrhages, are exceedingly rare entities. There are sporadic case reports of intrasyringal hemorrhages arising from intramedullary tumors, trauma, anticoagulation, or syringomyelic cavities secondary to Chiari malformations. Management is typically tailored to the underlying pathology. Given the paucity of literature, the clinical course and management modalities remain poorly defined. METHODS We present the case of a 19-yr-old male with a complex pasat medical history significant for Pierre Robin sequence, cervicomeddulary dysfunction with posterior fossa decompression and occipital-cervical fusion, hydrocephalus with fourth ventricular outlet fenestration, ventriculoperitoneal shunt conversion to ventriculoatrial shunt, and complex syringomyelia with thoracic syringo-subarachnoid shunt. Our patient presented to us with 3 wk of acute decompensation with complete loss of lower extremity function and a mid-thoracic sensory level. An magnetic resonance imaging (MRI) demonstrated an extensive dilation of his known syrinx with associated accumulation of heterogeneous blood products within the cavity encapsulating the syringo-subarachnoid shunt. RESULTS We performed a prompt revision thoracic laminectomy to identify the patient's existing syringo-subarachnoid shunt. Once the shunt was identified we performed a myelotomy overlying the existing shunt, and immediately noted high pressure chronic hematoma exiting from the myelotomy site. We placed a new syringo-subrachnoid shunt and gently advanced the catheter superiorly while gently irrigating the syrinx cavity. We continued to irrigate the cavity until the blood products cleared and fluid resembling cerebrospinal fluid returned from the cavity. The postoperative MRI demonstrated overall decreased size of the syrinx with less intrasyringal hemorrhage. The patient had a slight improvement in his thoracic sensory level at short-term follow-up. CONCLUSION Intrasyringal hemorrhages are exceedingly rare pathologic entity which may cause significant dilation of an existing syrinx even in the presence of a syringo-subrachnoid shunt. Exam features are variable but may demonstrate an acute and drastic progression. Prompt surgical intervention may improve functional neurologic prognosis.

Transfascial suture fixation technique in laparoscopic repair of inguinal hernia.

IntroductionThis study presents the initial results of a transfascial suture mesh fixation technique. This method was devised to reduce operative costs and foreign body‐associated risks while embracing the benefits of fixation in laparoscopic inguinal hernia repair.Materials and Surgical TechniquePatients undergoing laparoscopic inguinal hernia repair with transfascial suture fixation (TRANSFIX) in our center between March 2017 and March 2018 were retrospectively reviewed. The procedure is orchestrated by a reusable fascial closure device sequentially puncturing the fascia vertically through the inferior port site and guiding a polypropylene thread through the mesh. The thread is retrieved from the extraperitoneal plane with the device, creating an extracorporeal suture loop to embed a surgical knot at the subcutaneous layer of the port site.DiscussionIn its first year after introduction, 16 TRANSFIX were performed. All patients were men (mean age, 62.6 years). Thirteen hernias (81.3%) were first occurrence, and three (18.8%) were recurrent. Twelve (75.0%) were direct hernias, and three (18.8%) were indirect hernias; one patient presented with concurrent direct and indirect hernia. Median operating time was 41.5 minutes for unilateral repair and 73.0 minutes for bilateral. Median blood loss was 5 mL. One patient had a seroma after unilateral indirect hernia repair. After a median follow‐up of 15.5 months (range, 9‐21 months), no patient had chronic pain, wound infection, hematoma, or recurrence. Instrumental cost reduction per operation was between $150 and $300. TRANSFIX appears to be a safe and economical mesh fixation method.

A different aspect of the unexpected death of Mozart at the age of 35 years.

The cause of the early death of Wolfgang Amadeus Mozart (1756-1791) at the age of 35 has been the source of much discussion in the medical community. Investigators attributed to Mozart nearly 150 different medical diagnoses. However, the neurosurgical aspect of the early death of Mozart has yet to be well-analyzed, and this subject was investigated herein. The key words "Mozart" and "Mozart's death" were searched in PubMed as well as the libraries of universities. The main source was the archive and website of Internationale Stiftung MOZARTEUM/Salzburg (www.mozarteum.at) and the cranium stored in the Internationale Stiftung Mozarteum in Salzburg/Austria. The linear fracture of the cranium is important, since it shows the neurosurgical aspect of the early death of Mozart. Mozart's disease was most likely a neurotraumatologic one. His fracture likely occurred several months before his death, as evidenced by signs of healing. Intense headaches and declining musical performance in his last year may have been influenced by intracranial hemorrhage induced by the linear fracture. His final disease therefore may have been chronic postconcussion syndrome depending on chronic calcified epidural hematoma.

Long-Term Outcomes for Pediatric Patients with Brain Arteriovenous Malformations Treated with Gamma Knife Radiosurgery, Part 2: The Incidence of Cyst Formation, Encapsulated Hematoma, and Radiation-Induced Tumor

Long-term data about the incidence of late adverse radiation effects (AREs) in pediatric brain arteriovenous malformations (AVMs) treated with Gamma Knife radiosurgery (GKRS) are lacking. This study addresses the incidence of late AREs, including cyst formation (CF), chronic encapsulated hematoma (CEH), and radiation-induced tumor, in pediatric patients with AVM treated with GKRS. This is a single-institutional study involving pediatric patients with AVM who underwent GKRS between 1991 and 2014. Among 201 pediatric patients with AVM (age ≤15 years), 189 who had at least 12 months of follow-up were assessed in this study. The median treatment volume was 2.2 cm3, and the median marginal dose was 20 Gy. The mean follow-up period was 136 months. During the follow-up period, symptomatic radiation-induced perilesional edema was found in 5 patients (3%), CFs in 7 patients (4%), CEHs in 7 patients (4%), and radiation-induced tumors in 2 patients (1%). The cumulative incidences of late AREs including CF, CEH, and radiation-induced tumor were 1.2% at 5 years, 5.2% at 8 years, 6.1% at 10 years, 7.2% at 15 years, and 17.0% at 20 years. In the multivariate analysis, treatment volume alone was a significant factor for late AREs (P < 0.001; hazard ratio, 1.111). GKRS is a reasonable treatment option for pediatric AVMs to prevent future intracranial hemorrhages, particularly in the eloquent regions. However, considerable attention should be paid to late AREs such as CFs, CEHs, and radiation-induced tumors because of longer life expectancy in pediatric patients.

Meta-analysis of the use of sterilized mosquito net mesh for inguinal hernia repair in less economically developed countries.

BackgroundInguinal hernias are common in less economically developed countries (LEDCs), and associated with significant morbidity and mortality. Tension‐free mesh repair is the standard treatment worldwide. Lack of resources combined with the high cost of commercial synthetic mesh (CSM) have limited its use in LEDCs. Sterilized mosquito net mesh (MNM) has emerged as a low‐cost, readily available alternative to CSM. The aim of this systematic review and meta‐analysis was to evaluate the safety and efficacy of MNM for the use in hernia repair in LEDCs.MethodsA systematic review and data meta‐analysis of all published articles from inception to August 2018 was performed. Cochrane Central Register of Controlled Trials, MEDLINE and Embase databases were searched. The primary outcome measure was the overall postoperative complication rate of hernia repair when using MNM. Secondary outcome measures were comparisons between MNM and CSM with regard to overall complication rate, wound infection, chronic pain and haematoma formation.ResultsA total of nine studies were considered relevant (3 RCTs, 1 non‐randomized trial and 5 prospective studies), providing a total cohort of 1085 patients using MNM. The overall complication rate for hernia repair using MNM was 9·3 per cent. There was no significant difference between MNM and CSM regarding the overall postoperative complication rate (odds ratio 0·99, 95 per cent c.i. 0·65 to 1·53; P = 0·98), severe or chronic pain (OR 2·52, 0·36 to 17·42; P = 0·35), infection (OR 0·56, 0·19 to 1·61; P = 0·28) or haematoma (OR 1·05, 0·62 to 1·78; P = 0·86).ConclusionMNM has a low overall postoperative complication rate and is unlikely to be inferior to CSM in terms of safety and efficacy. MNM is a suitable low‐cost alternative to CSM in the presence of financial constraint.

Dual Chronic Ossified Epidural Hematomas Presented with Seizures 23 Years after Head Injury in an Adult Male: Case Report and Literature Review

AbstractThe authors report a rare case of dual chronic ossified epidural hematomas (EDHs) in a 35-year-old man with complaint of seizures after 23 years of head injury. Ossified EDH is a rare entity, and it commonly presents in pediatric age group. Presenting symptoms include headache and very rarely seizures. Asymptomatic cases may produce symptoms after decades; hence, regular follow-up is required. Treatment includes craniotomy or conservative management.

A Case Report of Chronic Expanding Hematoma Initially Misdiagnosed as a Soft Tissue Sarcoma

A Case Report of Chronic Expanding Hematoma Initially Misdiagnosed as a Soft Tissue Sarcoma

Growth Potential of Subdural Hematomas Under Clinical Observation: Which Subdural Hematomas Tend to Grow and Why They Do.

To study the prognoses of patients with subdural hematoma (SDH) who were not operated on at the time of the first diagnosis and the causes of enlarged hematomas in some patients during the follow-up period. The records, service files, and radiologic examination results of the patients with diagnoses of SDH were reviewed. The SDH patients were recorded under 5 different categories: acute SDH (ASDH), subacute SDH (SSDH), chronic SDH (CSDH), acute component with chronic SDH (A-CSDH), and subacute component with chronic SDH (S-CSDH). The symptoms, clinical findings, and progression in the patients were correlated with radiologic examinations. A total of 291 patients received diagnoses of SDHs: 80 patients with acute, 29 patients with subacute, and 163 patients with chronic hematoma. Thirty-five patients had diagnoses of SDH with a combination of different components. It was determined that in the follow-up period, patients with A-CSDH showed the greatest increase in hematoma size over time and required surgical intervention the most often. SDHs reveal different prognoses in different age groups. Multicomponent SDHs are within the group that shows the greatest increase in size in the follow-up period. SDHs and CSDHs cause recurrent hemorrhages by sustaining the tension on the bridging veins. The greater the hematoma volume, the greater the growth potential of the hematoma tends to be. CSDHs that do not manifest changes in volume for a long time can be monitored without surgical intervention as long as the clinical picture remains stable.

Chronic Expanding Hematoma on the Chest Wall after Mastectomy.

Chronic Expanding Hematoma on the Chest Wall after Mastectomy.

Infected subdural hematoma caused by Edwardsiella tarda.

Objective: Both infected subdural hematoma (ISH) and Edwardsiella tarda infections are rare in humans. E. tarda is a motile, facultative anaerobic, gram-negative rod bacterium, which is isolated from fresh or brackish water, but not usually from humans. Extra-intestinal E. tarda infections are rare and might cause severe clinical symptoms. However, ISH caused by E. tarda has not been reported previously. We report the first case of ISH due to E. tarda.Patient: A 76-year-old man was admitted to our hospital with a headache, loss of appetite, and nausea. Computed tomography revealed bilateral subdural hematoma.Results: We performed burr hole drainage. A hematoma with pus was found on the left side and chronic hematoma was found on the right side. Consequently, we diagnosed him with ISH on the left side and chronic subdural hematoma on the right side. E. tarda was detected in a culture from the hematoma with pus on the left side. As postoperative antibiotic therapy, we administered ceftriaxone and metronidazole for 47 days. The patient was discharged with no residual neurological deficit.Conclusion: Our case implied that favorable outcomes can be obtained by drainage and appropriate antibiotic therapy for ISH caused by E. tarda.

Chronic Unresolved Haematoma of Thigh with Acute Expansion- Emulating Neoplasm

Chronic Unresolved Haematoma of Thigh with Acute Expansion- Emulating Neoplasm

Cauliflower Ear Secondary to a Chronic Auricular Hematoma

Cauliflower Ear Secondary to a Chronic Auricular Hematoma

Post Traumatic Chronic Encapsulated Intracerebral Hematoma in a Child: Case Report and Brief Review of Literature

Chronic encapsulated intracerebral hematoma (CE-ICH) is an uncommon pathology that presents with headache, seizure, focal neurological deficits, or as a tumor. Trauma as a cause for CE-ICH is even rare and we believe this is the first case report as “trauma causing chronic encapsulated intracerebral hematoma “search in PubMed did not reveal any results. Repeated micro-hemorrhages in the CM or AVM are supposed to cause this lesion which progress from an earlier encapsulated phase to a thick capsulated stage with edema and clinical symptoms. CT or MRI is the diagnostic modality and it mimics, tumor, AVM, CM, angiomableed, cerebral abscess, metastatic mass or neurocysticercosis. Burr hole, mini-craniotomy, craniotomy, CT guided stereotactic aspiration or endoscopic excision are some options with equally good results. The present case with history of trauma was managed successfully with craniotomy with no recurrence for past one year. Nepal Journal of Neuroscience, Volume 14, Number 3, 2017, page: 46-48

Mięsak jasnokomórkowy tkanek miękkich podudzia

Przedstawiono przypadek 78-letniej pacjentki z mięsakiem jasnokomórkowym tkanek miękkich podudzia lewego imitującym przewlekły krwiak. Omówiono tytułową jednostkę chorobową i proces diagnostyczny ze szczególnym uwzględnieniem roli badania ultrasonograficznego.

Management of subdural chronic hematoma in Colombia: national survey

Abstract Chronic subdural hematoma is a growing neurological pathology, especially in older people. Thus, describing how this entity is approached in Colombia is of great importance because it allows to evaluate and contrast this approach with that of other countries, comparing the techniques used, therapeutic management and additional measures. In this study, this comparison was carried out using a self-administered survey with 16 multiple-choice items. The results were evaluated in Microsoft Excel, determining measures of central tendency accompanied by frequencies and percentages. As an initial management, 75.5% preferred to use 1Burr Hole and, in cases of recurrence, craniotomy is the choice in 50% of cases. Regarding the placement of drainage, its use was estimated to be 83.3%, especially the subdural system closed to external drainage, with a preference of 85.2%, and without use of corticosteroids as adjuvant therapy in 88.9 % of respondents. These data are consistent with the results of studies in other countries regarding the management of this pathology.

Age comparative study of chronic sub dural hematoma and its outcome :- A retrospective study

Age comparative study of chronic sub dural hematoma and its outcome :- A retrospective study

Role of outer membrane histopathology and comparison of clinico-radiological aspects of chronic subdural hematoma in different age groups: a retrospective study

Background: The incidence of chronic subdural hematoma (CSDH) has been found to increasing in younger patients. This study was aimed to evaluate the role of outer membrane histopathology and comparison with the clinic-radiological aspects of chronic subdural hematoma in different age groups.Methods: Cases of CSDH admitted to the Neurosurgery department during January 2014 and December 2016 were included in the study. They were analyzed clinically, radiologically like site, size, thickness in computed tomography, the attenuation value and midline shift. Histopathological features were also recorded. Cases of acute and chronic sub dural hematoma which were managed conservatively irrespective of age and sex were excluded from the study.Results: Total 196 patients were included with median age of 66 yrs. The most common histopathological type of membrane was the scar inflammatory membrane (Type IV) in 43% of cases followed by hemorrhagic inflammatory membrane (Type III) in 31% of cases while the scar inflammatory type of membrane (Type II) was in 26% of cases. Young age group patient having less thickness of hematoma (&lt;2cm) and having hyper density on CT scan. Old age group had more thickness(3.2cm) and mixed density with multiple layering.Conclusions: Young age group patient having less thickness of hematoma and hyper density compared to old age group. Recurrence and bilateral disease were more common in old age group associated with brain atrophy. Histopathological study completes the spectrum of CSDH in terms of severity of disease and overall prognosis of patient.

RESULTS OF MAGNETIC RESONANCE IMAGING AND COMPUTERIZED TOMOGRAPHY DURING SURGERY OF CHRONIC SUBDURAL HEMATOMA IN HOP LUC GENERAL HOSPITAL - THANH HOA

Consequence of traumatic brain injury as intracranial hematomas are severe complications with disability and high mortality. The diagnosis and treatment are difficult expecially for provincial hospitals. Chronique subdural hematoma (SDH) could occur at any age but mostly in the elderly. Clinical symptoms of chronic SDH often fuzzy, nonspecific. The large hematoma trường hợpuses prolonged tamponade leading to irrversible damage in the brain. The consequences may lead to death or severe sequelae. With actual advances in diagnostic imaging and neurosurgical techniques, chronic SDH may be considered benign lesions. With early detection, timely treatment, the results will be very positive. From 2007 – 2014 we operated 97 caes of chronic SDH with good results. Key words: chronic hematoma, result MRI and CT Scanner, chronic capillary surgery