Encapsulated hematoma - distal thigh

Case contributed by Dr Maulik S Patel

Presentation

A large swelling on the distal anteromedial side of the left thigh, non-penetrating injury to distal thigh 6 months prior.

Patient Data

Age: 40 years
Gender: Male
X-ray

Left thigh

There is a well-defined soft tissue density lesion ( about 100 x 90 x 90 mm ) on the anteromedial side of the distal thigh region.

There is no bony abnormality.

Ultrasound

Left thigh

There is an encapsulated cystic lesion in the subcutaneous plane of the distal third of the left thigh. It is in anteromedial side of thigh. There is a thin avascular capsule ( < 2 mm )  around the lesion. There are internal avascular multiple septa. There are a few echogenic fat globules in the lesion. Approximate size of the lesion is 100 x 90 x 85 mm. Underlying muscles are normal.

Intra-operative and post excision photos show a well-defined lesion.

Pathology

Photos show an external surface and cut section of the lesion.

Pathology

Microscopic findings described in case discussion.

Case Discussion

An adult male had a non-penetrating injury to the distal third of the left thigh on the anteromedial side. There was a gradual development of local swelling after 2~3 weeks on the injury. There is no pain at the time of presentation. Ultrasound 6 months following injury shows an encapsulated collection in the subcutaneous plane of the thigh.

Gross pathology description: A single soft tissue piece, globular, brown-white, cystic, measuring 110 x 93 x 72 mm, weighing 336 grams. The cut section shows thick reddish hemorrhagic fluid without solid areas on the inner side of the cyst wall.

Microscopic description: Features are consistent with the clinical diagnosis of an organized hematoma. There is inflammation with reactive multinucleated giant cell reaction present. There is no malignancy or tuberculosis.

Diagnosis: Organized hematoma of the left thigh

Intraoperative photos courtesy: Operating surgeon Dr. Ritesh Patel.

Pathology photos and report courtesy: Dr. Bharat Tandel.

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Case information

rID: 71095
Published: 21st Sep 2019
Last edited: 24th Sep 2019
Inclusion in quiz mode: Included

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