Large Subcutaneous Hematoma Research Articles

An autopsy case of internal jugular vein thrombophlebitis involving sepsis following blunt neck injury

We report an unusual case of delayed death due to sepsis following closed blunt injury to the neck. The victim was a 71-year-old male with a clinical history of hypertension, diabetes and gout. He was found dead about three weeks after being assaulted. He had not consulted a hospital after the assault. Forensic autopsy demonstrated a large liquefied subcutaneous hematoma on the right side of the neck, peri- and thrombophlebitis of the right internal jugular vein. Otherwise, there was no evidence of trauma. Histological examination showed dermal vesicles in the skin covering the hematoma, accompanied by marked inflammatory cell infiltration phagocytosing gram-positive streptococci, subcutaneous edema, panphlebitis with partially organized thrombi and bacterial colonies, pulmonary edema and multiple pulmonary microthrombi involving bacterial aggregates. Postmortem serum C-reactive protein and neopterin levels were markedly elevated. These findings suggest sepsis as the cause of death, induced by infected internal jugular vein thrombophlebitis following blunt neck injury involving impaired skin barrier.

Recurrent Massive Subcutaneous Hemorrhage in Neurofibromatosis Type 1: A Case Report

Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that has three major features: multiple neural tumors, café-au-lait spots, and pigmented iris hamartomas (Lisch nodules). The purpose of this case report is to advise physicians of the danger associated with the progression of fast-onset massive hemorrhage to hemodynamic instability, which mandates rapid treatment to prevent the development of a life-threatening condition. A 64-yr-old woman with NF-1 was admitted to the Emergency Department (ED) because of a rapidly growing, 10×5×3 cm-sized mass on the left back area. She had previously undergone surgery for a large subcutaneous hematoma, which had developed on her right back area 30 yr before. She became hemodynamically unstable with hypotension during the next 3 hr after admission to ED. Resuscitation and blood transfusion were done, and the hematoma was surgically removed. The mass presented as a subcutaneous, massive hematoma with pathologic findings of neurofibroma. We report a case of NF-1 that presented as recurrent, massive, subcutaneous hemorrhage on the back region combined with hypovolemic shock.

Fréquence et causes des mauvais résultats de l'arthroscopie du poignet

Arthroscopy represents a new and promising technique for the diagnosis and treatment of disorders of the wrist. Causes predis posing to clinical failure can arise during any phase of the approach to a patient who is a candidate for arthroscopic treatment. The author examine the causes of failure during pre-operative diagnostic workup, operative procedure and post-operative rehabilitation program and discus how to prevent them. Three hundred fifty outpatients who had wrist arthroscopy were reviewed to determine type of procedure, type of anaesthetic, portals used and incidence and nature of preoperative, operative, and postoperative complications. Complications were divided in two groups: major and minor. The first group consists of isolated or combined vascular, nerve and/or tendon injuries, compartment syndrome joint infection and RSD, wrist rigidity. The second group includes transient superficial dorsal ulnar sensory neurapraxia, superficial portal sit infection, skin burns, tendonitis, instrumentation breaking inside the wrist joint, ganglion formation, haematomas. In a separate group othe causes of failure, especially those due to surgical or rehabilitation failures, are considered. Ten cases of surgical and post-surgical complications (2,9%) and 8 other cases of failure considered separately (2,3%) were identified, making a total of 18 cases of clinical failure (5,1%). Among these complications 4 cases were classified as "major" [sensory nerve branch lesions of ulnar nerve (3 cases) and of radial nerve (1 case)] and 6 cases were classified as "minor" [sensory neurapraxia (3 cases), instrumentation breakage (1 case), ganglion formation (1 case), a large subcutaneous haematoma (1 case)]. Wrist arthroscopy is a sophisticated procedure, requiring dedicated surgical training and a thorough knowledge of joint disorders in order to lower the risks of complications and surgical failures.

Spermatic cord injury associated with blunt trauma

Spermatic cord injury due to blunt trauma is an entity rarely encountered in clinical practice, and it may be mainly characterized by the onset of severe pain, swelling, or hematoma in the groin area. We present a case of a fresh spermatic cord injury caused by blunt trauma, which was correctly diagnosed after a surgical exploration. A 53-year-old healthy man had a strong blow from a handlebar on the right groin region in a motorcycle accident. He was transferred to our hospital from a rural hospital 3 hours after the accident because a hematoma was suddenly expanding in the right groin. On presentation, a 12 cm diameter painful subcutaneous hematoma of the right groin extending into the right hemiscrotum was found (Fig. 1). There was no medical history of blood dyscrasias, anticoagulant therapy, inguinal hernia, or urinary symptoms. His vital signs were normal. Contrast-enhanced computed tomographic (CT) images showed a large subcutaneous hematoma with contrast medium extravasation at the groin level and the edematous spermatic cord at the pudendal level (Fig. 2). There was no evidence of either any external iliac or femoral artery injuries. The preoperative diagnosis was a large subcutaneous hematoma bleeding from disrupted subcutaneous vessels. He was taken to the operating room for the removal of the hematoma and hemostasis 5 hours after the accident. Under satisfactory spiral anesthesia, an 8-cm diagonal incision was made over the hematoma of the right groin. A large subcutaneous hematoma as well as the contused spermatic cord was found. The cord was severely damaged at a level approximately 4 cm distal from the internal inguinal ring, and it was bleeding modestly from the internal or external cremasteric vessels. A large hematoma was contained along the distal length of spermatic cord. The vas deferens was intact. A rupture of external oblique aponeurosis and transverse fascia was found after removing the 300-g subcutaneous hematoma. A search for these layers resulted in the discovery of preperitoneal fat without any active bleeding. Based on these findings, a right orchiectomy was performed, and then, the floor of the inguinal canal was repaired by joining the edge of the internal muscle and aponeurosis of the transverse oblique muscle to the Poupart ligament. The external oblique aponeurosis was

Physical Restraint and Subcutaneous Hematoma in an Anticoagulated Patient

A large subcutaneous hematoma extending from the breastbone region to the left axillary region and left flank developed in a 86-year-old anticoagulated man because of repeated microtrauma from a physical restraint used to prevent his rising from a chair. Physicians, nurses, and physiotherapists should recognize that physical restraints causing pressure on the skin increase hemorrhagic risk in patients who take low molecular weight heparin. Accordingly, they should systematically check for hemorrhagic complications and attempt to limit the use of such devices.

Physical Restraint and Subcutaneous Hematoma in an Anticoagulated Patient

A large subcutaneous hematoma extending from the breastbone region to the left axillary region and left flank developed in a 86-year-old anticoagulated man because of repeated microtrauma from a physical restraint used to prevent his rising from a chair. Physicians, nurses, and physiotherapists should recognize that physical restraints causing pressure on the skin increase hemorrhagic risk in patients who take low molecular weight heparin. Accordingly, they should systematically check for hemorrhagic complications and attempt to limit the use of such devices.

Life-Threatening Subcutaneous Hematoma Caused by an Axillary Pad in an Anticoagulated Patient

A large subcutaneous hematoma extending from the left axillary region to the left flank developed in a 70-year-old man receiving anticoagulant therapy. The cause was repeated microtrauma caused by the axillary pad on a walker. Physicians and physiotherapists should be aware that rehabilitation devices causing pressure on the skin increase hemorrhagic risk in patients taking anticoagulants. Accordingly, these patients should systematically be checked for hemorrhagic complications, and the use of such devices should be limited.

Traumatic transection of the intrapancreatic common bile duct due to blunt injury: a case report and literature review

An N-year-old previously healthy man was brought by the Emergency Medical Team to our hospital, an hour after being beaten up by a gang of young men. He had been beaten all over his body including several blows to his abdomen. He was conscious (Glasgow Coma Scale 13), although agitated. Vital signs were, heart rate 116 beats/ min and BP 110/‘70 mmHg. His only complaint was of diffuse abdominal pain. On physical examination, ecchymoses and contusions were absent, no penetrating wounds were present and a small laceration of 3 cm on the lower lip was noted. Lung examination was normal. The abdomen was flat with diffuse tenderness in all four quadrants. There were no other abnormalities. Because of his intoxicated and agitated state the patient was sedated and anaesthetized and an elective intubation was performed. At this point a nasogastric tube was inserted and brought up 300 cm3 of coffee-ground material. A urinary catheter was inserted with good urine output and no signs of haematuria. X-Rays of the chest, pelvis and cervical spine were normal. Computed tomography (CT) of the head revealed findings of a small frontal intracerebral bleed. There were no signs of increased intracranial pressure (Figure 2). CT of the abdomen showed free fluid in the abdominal cavity extending from the subhepatic region to the pelvis. The spleen and liver were intact (Figure 2). Because of the intact spleen and liver and the presence of free fluid in the abdomen, the abdomen was explored. A large subcutaneous haematoma was observed in the epigastric regtion, and 500 cm3 of fresh blood was aspirated from the peritoneal cavity. A large haematoma was detected in the retroperitoneum extending from the duodenum down to the sacral region. A blotch of bile was found staining the upper portion of the first part of the duodenum. A Cattell procedure was performed and the duodenum was mobilized using the Kocher manoeuvre, at which time a blowhole of 2 mm by 3 mm was observed in the duodenum, approximately in the middle of the 1st to 2nd division of the organ. Exploration of the common bile duct showed an intact duct. During the procedure bile was noticed to exude from

Fatal haemorrhage associated with neurofibromatosis

cold and mottled with no pulses palpable below the axilla, suggesting a major vascular injury at the fracture site. Profuse haemorrhage from the upper arm was controlled initially by compression bandaging, although a large subcutaneous haematoma developed in the left pectoral region. There was no clinical or radiological evidence of intrathoracic or intraperitoneal haemorrhage. It was rapidly established that the left arm had been functionally almost useless due to the pre-existing diffuse neurofibromatosis and it was therefore decided to proceed to primary amputation. The tibial fracture was first treated by internal fixation. In the course of the upper limb amputation (which was too high for tourniquet control) further profound haemorrhage was encountered from numerous dilated thin-walled vascular channels in the subcutaneous tissue. The axillary artery was also abnormally thin-walled, with extensive traumatic lacerations but showing no evidence of vasospasm. Haemostasis was initially achieved by ligation of the axillary vessels and closing the stump around gauze packs. Following the operation the patient developed a severe coagulopathy and recurrent haemorrhage which was controlled by radiological embolisation of the axillary artery. The patient required 88 units of blood and blood products in the first 24 hours. He subsequently developed multiple organ failure and died 27 days after the initial injuries. At post mortem many of the features of neurofibromatosis were present. There was marked kyphoscoliosis and hundreds of discrete neurofibromata were present throughout the body. There was also diffuse proliferation of neural tissue (diffuse neurofibromatosis) infiltrating skin, subcutaneous tissue, muscles, fat and many of the viscera. Numerous thinwalled, ectatic blood vessels were present throughout the skin, subcutaneous tissue and muscle. These were in direct relation to the abnormal neural proliferation. Histological examination of the axillary artery showed distortion of the lumen and infiltration of the wall by diffuse neurofibromatosis (Fig. 2).

Operative treatment of the large post-traumatic subcutaneous haematoma or bursa

A study of the large subcutaneous haematoma or bursa was carried out in 85 adult patients who were mostly injured in traffic accidents as pedestrians hit by automobiles or in motorcycle accidents. The lesions, mostly located at trochanteric and lumbosacral regions, were produced by direct, tangential traumatic forces splitting the subcutaneous fat from the fascia and creating a massive haematoma which was subsequently transformed into a real bursal cyst, resistant to the conventional methods of treatment. As the results of conservative measures were unsatisfactory in 74 per cent of cases, a simple operation has been developed, consisting of excision of the bursal wall and inserting cutaneofascial sutures to allow complete elimination of any dead spaces where tissue fluids could re-accumulate. As the results of this operation were favourable in 95 per cent of cases, it is recommended for the management of this condition.

Recurrent dislocation of the patella treated by the modified Roux-Goldthwait procedure. A prospective study of forty-seven knees.

We studied the results in forty-seven knees in thirty-seven patients - ten male and twenty-seven female - who had recurrent dislocation of the patella and were treated by a modified Roux-Goldthwait procedure (lateral retinacular release, medial transfer of the lateral patellar tendon without advancement, plication of the medial retinaculum, and advancement of the vastus medialis). Ten of the female patients had bilateral dislocation. The results were analyzed after follow-ups ranging from 3.0 to 16.3 years (average, 5.8 years). The study confirmed that a tangential radiograph of the patellofemoral joint, made with the knee in 20 degrees of flexion, is reliable in determining patellar displacement. The results were excellent in twelve knees, good in thirty-one, fair in one, and poor in three. The fair and poor ratings were due to pain caused by severe chondromalacia patellae. The patient with a fair result had had recurrent dislocations after the Roux-Goldthwait procedure due to a very lax synovial and capsular sac. Reoperation with tightening of the sac medially and laterally eliminated hypermobility of the patella in this patient and established straight patellar tracking. There was one serious complication, a large subcutaneous hematoma with necrosis of a skin flap. The patients with mild chondromalacia improved and showed no progressive patellofemoral arthritis after simple realignment, while those with severe chondromalacia were not improved by shaving, drilling, and realignment. Preliminary results indicated that a modified Maquet procedure, in addition to realignment, may be indicated for patients with severe chondromalacia. This study demonstrated that the modified Roux-Goldthwait procedure, without advancement of the tibial attachment of the patellar ligament, can stabilize the patella without increasing patellofemoral compression. The procedure does not relieve the symptoms of severe chondromalacia of the patella but realignment is the first step in treatment of any form of patellofemoral arthrosis.

Organophosphorus cholinesterase inhibitors and fetal development

Albino rats at various stages of gestation were treated with isofluorophate, parathion, and methyl parathion. A reduction in fetal cerebral cortical cholinesterase activity was observed consistently indicating transplacental passage of the lipoid soluble phosphorothioates used in this study. Large subcutaneous hematomas were found in several offspring of the parathion- and methyl parathion-treated groups but no significant developmental defects were observed. High stillbirth and neonatal death rates occurred in the offspring of all treated animals and the average weight gain in surviving animals during the first 40 days of life was uniformly less than that of the control group.