‘Ancient’ haematoma

Case
A 41-year-old male player presents with a history of recurring calf pain and swelling. He describes recurring calf pain after activity since an index injury 15 years previously. He has also noted an asymmetry in appearance between his calves. On examination there was an obvious swelling distal to the medial head of gastrocnemius and an increased calf circumference (4cm greater on the symptomatic side).

Findings
On the lateral x-ray view, there are two serpiginous foci of mineralisation within the posterior soft tissues in the right mid-calf. These appearances most likely reflect dystrophic calcification related to prior trauma. The ultrasound images show a large hypoechoic area with a smooth and regular border. The MRI sequences show a well-defined ovoid fluid collection at the distal myotendinous junction of medial gastrocnemius. It has a thin low signal margin and is predominantly filled with T1 and T2 high-signal fluid, suggestive of proteinaceous material. This is in keeping with a walled off haematoma with a haemosiderin rim and is consistent with a previous myotendinous junction tear.

Discussion
The imaging findings were discussed with the player. A coagulation screen was performed and was found to be normal. There was a discussion about several different treatment options including further observation (given that his symptoms had not been too concerning), aspiration and surgical evacuation. It was decided that aspiration would be attempted. A total of 50mls of dark-red serous material was aspirated. This was found to contain moderate numbers of inflammatory cells, including macrophages, on a background of blood. It was felt that this was consistent with an inflamed cyst with haemorrhage. After three-month follow up there was no evidence of either infection or recurrence. The player had returned to sport and was satisfied with the results.

‘Ancient’ haematoma is one of several lesions that require differentiation from soft tissue neoplasms. This entity is a benign soft tissue tumour surrounded by a fibrous pseudo-capsule with inflammatory cells present inside the capsule. In most cases it gradually expands in size over time.

The vast majority of haematomas are easy to diagnose on the basis of a patient’s history, clinical examination and/or imaging studies. ‘Ancient’ haematomas are however very rare, and the diagnosis is based on the exclusion of other pathologies. The protracted time interval between the traumatic event (or sometimes surgery) and mass development can hinder the diagnosis. A recent case review only identified 208 cases of ‘ancient’ hematoma with only three cases involving the calf. In all these three cases surgery was performed.

Important notice
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Dr.Aniemena-George ChidiMark FulcherDr Aniemena-George ChidiBangoura Recent comment authors
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Bangoura
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Bangoura

Un hématome.de quelque nature que ce soit doit être vu par un spécialiste.
Avoir à l esprit qu’ un Massage précoce est une contre indication formelle dans un cas hématome. Une échographie et l IRM sont mieux indiquée en matière d imagerie pour un diagnostic clair.
Un massage précoce entraîne toujours une CALCIFICATION.
Faire un drainage ou une ponction exploratrice ou evacuatrice.la seringue nous ramène le plus souvent un liquide SEROHEMATIQUE..le plus souvent une hemarthrose.
Demander un ECB avec ANTIBIOGRAMME.du liquide pour besoin de traitement.
Physiothérapie.AINS.ATB.
Inciser si présence d une calcification
Reprise progressive avec un bon suivi medical

Bangoura
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Bangoura

LIRE plutôt un hématome de quelque nature que ce soit doit être vu par un spécialiste.avoir à l esprit qu’ un Massage précoce est une contre indication formelle dans un cas d hématome.laseringue nous ramène le plus souvent un liquide SEROHEMATIQUE ou une hemarthrose
Demander un examen cyto bactériologique avec antibiogramme

Bangoura
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Bangoura

Un massage précoce est une contre indication en cas d hématome.un hématome quelque soit sa nature doit être vu par un spécialiste surtout si c est un sportif

Bangoura
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Bangoura

Je dis bien CONTRE INDICATION FORMELLE

Dr Aniemena-George Chidi Chinenye
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Dr Aniemena-George Chidi Chinenye

What’s the probability of reoccurrence with regard to Ancient hematomas post surgery.

Mark Fulcher
Member

This risk of recurrence appears to be pretty low. There are a very limited number of case reports that describe this problem – so it is hard to be completely sure. This is from a recent case report… “A search of PubMed articles published from 1970 to 2012 identified 208 cases of ancient hematoma. Of these, 79 cases were in the brain, 59 cases were in the thorax, 36 cases were in the lower extremity, 10 cases were in the abdomen, and 24 cases were in the upper extremity.” The paper is open source and seems indicative of the literature… Read more »

Dr Aniemena-George Chidi Chinenye
Member
Dr Aniemena-George Chidi Chinenye

How long will it take for Tramadol to be added to the list of banned substances in Football. The use of Tramadol is markedly on the rise in club sides in the West African sub region where there is very poor medical layout and care for footballers. These footballers sought for healing of their various injuries from traditional healers. Most develop chronic injuries due to poor management of these injuries. They resought to the use of these opoid derivatives to curb their pain,before and after games. Most even purposely ingest higher doses in the quest to conquer pain. Overtime, many… Read more »