Soft-Tissue Hematoma

The most common manifestations of hemophilia A are those caused by bleeding into soft tissues (hematomas) such as muscle or into body spaces such as the peritoneal cavity or the lumen of the gastrointestinal tract. When bleeding occurs repeatedly into joints (hemarthrosis), the joint may eventually become deformed and immobile. 

Fig. 12.8. Rupture of the corpus spongiosum. Longitudinal scan showing interruption of the echogenicline of the spon-giosal albuginea (arrow) and associated soft-tissue hematoma ( ). A catheter (arrowheads) is placed in the urethra...

A contusion is an injury to soft tissue in which the skin is not penetrated, but swelling of broken blood vessels causes a bmise. The bmise is caused by a blow of excessive force to muscle, tendon, or ligament tissue. A bmise, also known as a hematoma, is caused when blood coagulates around the injury causing swelling and discoloring skin. Most contusions are mild and respond well to rest, ice, compression, and elevation of the injured area. 

A 40-year-old woman had multiple bone injuries, severe sepsis, and coma after a car accident a retroperitoneal hematoma caused by lumbar fractures was drained, but she continued to be pyrexial (23). She had prominent accumulation of Ga, which had been used for bone scanning, in her multiple recent fractures and an area of accumulation in the soft tissue related to a fractured vertebra. Post-traumatic paravertebral calcifications had accumulated Ga and simulated the presence of an infected hematoma. 

An x-ray showed no fractures, but a soft tissue swelling, consistent with a hematoma (bleeding into the tissues), was noted. Sloe s mother related that soon after he began to crawl, his knees occasionally became swollen and seemed painful. 

The acute clinical onset in a patient under anticoagulation supports the diagnosis of a rectus sheath hematoma. MR imaging may be useful in differentiation of chronic rectus sheath hematomas from anterior abdominal wall masses such as lipoma, hemangioma, neurofibroma, desmoid tumor, soft-tissue sarcoma, lymphoma, or metastatic lesions. Although bleeding into neoplasm may occur, hyperintense regions are rarely observed in tumors [66]. 

Immediately after soft tissue implantation, a histological examination of the implant site shows a cellular response typical of acute trauma (hematoma), followed by the formation of a fibrous capsule around the implant (Chawla et ai, 1985). In osseous tissues, new bone formation begins to form periosteally and endosteally. Granulation tissue can be observed between the bone and the implant. A few giant cells are present, but no other inflammatory cells are observ ed (M ola et ai, 1991 Matsusue etal., 1991). 

Fig. 18.35 Posteroanterior chest radiograph from an elderly patient on dipyridamole and aspirin at the time of attempted implant in the left prepectoral region. Attempted venous puncture was complicated by axillary artery puncture and bleeding. The procedure was abandoned, and a pacemaker was placed several days later via the left axillary vein. However, on this posteroanterior radiograph obtained after the left-sided implant attempt, a very large hematoma was indicated by the marked soft tissue expansion on the left thorax. In addition, an area of greater opacity in the left prepectoral region is consistent with hematoma formation in the pectoral muscle and prepectoral tissues.

This lesion can occur when the erect penis is forcibly displaced towards the feet (Pryor and Hill 1979). Diagnosis of rupture of the suspensory ligament is made by history and by palpation of a gap between the base of the shaft of the penis and the symphysis pubis. An abnormal angle is noted during erection. Ultrasonography is able to document the gap between the pubis and the penile shaft and associated hematomas of the soft tissues (Fig. 12.5), but usually does not provide additional useful information (Bertolotto and Pozzi Mucelli 2004). 

US assessment of proximal hamstrings lesion can be difficult in cases of hypertrophied thighs because the insertion point is located deeply and the soft-tissues of the buttock may have a substantial thickness. In addition, any pressure exerted with the transducer in an attempt to reduce the distance between the affected tendons and the skin can be painful in acute phases. In complete tendon tears, US can demonstrate the discontinuity of the affected tendon, which appears retracted downward and surrounded by local hematoma, whereas the adjacent nonaffected tendon can he seen inserting normally into the hyperechoic cortex (Fig. 12.54). Partial tears can be more difficult to assess and differentiate from focal tendinopathy. In general, they extend more distally downward to reach the myo-... 

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