Presentation
Gluteal injection - 15 days back. C/o large local swelling , pain in gluteal region. USG to rule out abscess formation.
Patient Data
A hypoechoic well-defined lesion is noted involving subcutaneous fat and muscles. Only a small area of the lesion shows 'whirling' echoes.
The lesion is avascular. No significant perilesional hypervascularity.
Case Discussion
By knee jerk reaction due to history of post injection gluteal swelling - pain, it was reported to surgeon as an " odd " looking abscess. Next day surgeon called to say it was an hematoma.
Differentiating features in this case:
- It is well-defined lesion. Abscess should be illdefined.
- No perilesional echogenic fat seen in this. In Abscess there is central necrosis with perilesional shaggy wall which is surrounded by inflammed fat
- Mobile - whirling echoes are noted only a small part of the lesion. Abscess caviry shows whirling echoes in entire area.
- Wall / perilesional Hypervascularity is missing in this lesion. Abscess should have both.
There was no history of known medical disease / patient was not takening any oral anticoagulant.
Post operative, bleeding was more than usual.
WBC counts were not measureable by cell counter.
Patient may be having a kind of hematological disorder and is under work up.
Follow up : diagnosis - chronic myeloid leukemia.
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