Four Cases of Successfully Treated Chronic Expanding Soft Tissue Hematoma
Case 2 was a 54-year-old man who presented with a 10-year history of a large mass in the left thigh. The surface was dark-reddish, soft, fluctuant, and painless when palpitated. A firm subcutaneous tumor was situated lateral to the lesion. The patient had had an injection (detailed information was not available) in his left thigh during childhood, and a large hematoma initially appeared at the injection site. The hematoma resolved immediately, leaving a small induration that increased rapidly in size 1 year ago. His medical and family history was otherwise unremarkable except for having hepatitis B carrier status. Blood biochemistry, coagulation profile, and platelet counts were normal. An MRI scan demonstrated a well-circumscribed, subcutaneous, 4×4×5 cm cystic mass (). The patient underwent complete resection of the mass including the fibrous capsule, which had partly adhered to the fascia (). The lesion was removed surgically, and microscopically, the resection revealed a hematoma surrounded by a hyalinized fibrous capsule. No recurrence was detected within 2 years.\nA 66-year-old woman (Case 3) presented with a painful 6 months old and increasingly large swelling on the buttock. She had no history of trauma. Clinical and MRI findings revealed a tender 10×10 cm cystic swelling in the subcutaneous tissue. An incision biopsy confirmed that the swelling was a hematoma. Because the patient was receiving anticoagulant therapy including 2 mg/day warfarin potassium and 100 mg/day aspirin for anti-phospholipid antibody syndrome, the hematoma was aspirated rather than complete dissection. The mass has not recurred after 3 years.\nA 14-year-old girl (Case 4) noted a cystic, slightly tender, 1.5×1.5 cm swelling on the right upper arm 3 months prior to consultation. No inducible cause could be discovered and her history was unremarkable. She successfully underwent enucleation of the lesion at Kyushu University Hospital. Her condition was histopathologically diagnosed as CEH. The swelling has not recurred after 2 years.