Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that has three major features: multiple neural tumors, cafe-au-lait spots, and pigmented iris hamartomas (Lisch nodules). The purpose of this case report is to advise physicians of the danger associated with the progression of fast-onset massive hemorrhage to hemodynamic instability, which mandates rapid treatment to prevent the development of a life-threatening condition. A 64-yr-old woman with NF-1 was admitted to the Emergency Department (ED) because of a rapidly growing, 10x5x3 cm-sized mass on the left back area. She had previously undergone surgery for a large subcutaneous hematoma, which had developed on her right back area 30 yr before. She became hemodynamically unstable with hypotension during the next 3 hr after admission to ED. Resuscitation and blood transfusion were done, and the hematoma was surgically removed. The mass presented as a subcutaneous, massive hematoma with pathologic findings of neurofibroma. We report a case of NF-1 that presented as recurrent, massive, subcutaneous hemorrhage on the back region combined with hypovolemic shock.
Diagnosis, Differential ; Female ; Hematoma/etiology/pathology ; Hemorrhage/*etiology/pathology ; Humans ; Middle Aged ; Neurofibromatosis 1/*complications/pathology ; Recurrence ; Skin Diseases/*etiology/pathology ; Tomography, X-Ray Computed

Aged, 80 and over ; Dyspnea ; etiology ; Glottis ; pathology ; Hematoma ; complications ; Hemophilia A ; complications ; Humans ; Laryngeal Diseases ; complications ; Male

To explore the diagnoses and treatment of hemophilic pseudotumor, one case with hemophilic pseudotumor misdiagnosed and treated by operation, was observed and analyzed. The result showed that the final diagnosis of this case was following: hemophilia A (mild type) and hemophilic pseudotumor with injury of femoral nerve. The final diagnosis was given from inquiring case history and family history additionally, and drawing assistance from laboratory examination and computed tomography. After operation, the patient's wound healed very well through supplying coagulation factors positively. In conclusion, it was important for inquiring case history and family history particularly and thinking highly of laboratory examination to reduce the misdiagnosis and error of therapy for this case. If paying attention to preoperative preparation, the danger of hemorrhage during operation can be reduced and wound after operation can heal more rapidly.
Adult ; Diagnostic Errors ; Femoral Nerve ; pathology ; Hematoma ; diagnosis ; etiology ; Hemophilia A ; complications ; Humans ; Male

Percutaneous liver biopsy is valued in the diagnosis of diffuse or localized liver disease. Serious complications after ultrasonography-guided liver biopsy are rare. We report a case of a 69-year-old man who underwent a percutaneous liver biopsy for the evaluation of his underlying liver disease with subsequent late complication of intraluminal gallbladder hematoma.
Aged ; Biopsy, Needle/*adverse effects ; English Abstract ; Gallbladder Diseases/*etiology ; Hematoma/*etiology ; Human ; Liver/*pathology/ultrasonography ; Male ; Ultrasonography, Interventional

Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhancement.
Brain/pathology ; Case Report ; *Child Abuse ; Chronic Disease ; Female ; Hematoma, Subdural/diagnosis/*etiology ; Human ; Infant ; *Magnetic Resonance Imaging ; Male

We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolved in 12 (20.7%), reduced in 15 (25.9%), remained in 10 (17.2%), enlarged in 2 (3.4%), and changed into chronic subdural hematoma (CSDH) in 19 patients (32.8%). SDG was diagnosed at 11.6 days after the injury. It was enlarged at 25.5 days, remained at 46.0 days, reduced at 59.3 days, resolved at 107.5 days, and changed into CSDH at 101.5 days in average. SDGs were developed as delayed lesions, and changed sequentially. They enlarged for a while, then reduced in size. The final path of a SDG was either resolution or CSDH formation. Nearly half of SDGs was resolved or reduced within three months, however, 61.3% of unresolved or unreduced SDG became iso- or hyperdense CSDH. These results suggest that the unresolved SDG is the precursor of CSDH.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Craniocerebral Trauma/complications ; Disease Progression ; Hematoma, Subdural, Chronic/radiography* ; Hematoma, Subdural, Chronic/pathology* ; Hematoma, Subdural, Chronic/etiology ; Human ; Infant ; Longitudinal Studies ; Lymphangioma/radiography ; Lymphangioma/pathology ; Lymphangioma/etiology ; Middle Age ; Subdural Effusion/radiography* ; Subdural Effusion/pathology* ; Subdural Effusion/etiology ; Tomography, X-Ray Computed*

Spontaneous retroperitoneal hemorrhage is one of the most serious and often lethal complications of anticoagulation therapy. The clinical symptoms vary from femoral neuropathy to abdominal compartment syndrome or fatal hypovolemic shock. Of these symptoms, abdominal compartment syndrome is the most serious of all, because it leads to anuria, worsening of renal failure, a decrease in cardiac output, respiratory failure, and intestinal ischemia. We report a case of a spontaneous retroperitoneal hemorrhage in a 48-year-old female who had been receiving warfarin and aspirin for her artificial aortic valve. She presented with a sudden onset of lower abdominal pain, dizziness and a palpable abdominal mass after prolonged straining to defecate. Computed tomography demonstrated a huge retroperitoneal hematoma and active bleeding from the right internal iliac artery. After achieving successful bleeding control with transcatheter arterial embolization, surgical decompression of the hematoma was performed for management of the femoral neuropathy and the abdominal compartment syndrome. She recovered without any complications. We suggest that initial hemostasis by transcatheter arterial embolization followed by surgical decompression of hematoma is a safe, effective treatment method for a spontaneous retroperitoneal hemorrhage complicated with intractable pain, femoral neuropathy, or abdominal compartment syndrome.
Abdomen ; Anticoagulants/*adverse effects ; Compartment Syndromes/*etiology ; Female ; Gastrointestinal Hemorrhage/chemically induced/*congenital ; Hematoma/etiology/surgery ; Humans ; Iliac Artery/pathology/radiography ; Middle Aged ; Tomography, X-Ray Computed

We report the first case in Korea of a chronic expanding hematoma, which presented as a huge mass in the pleural cavity. A 67-year-old woman exhibiting a slowly-expanding intrathoracic mass, as revealed by a chest radiograph, was admitted to our hospital. The patient had undergone a pneumonectomy 37 years earlier during treatment for pulmonary tuberculosis. Computed tomography revealed a huge mass in her right hemithorax. The differential diagnosis of this mass included chronic empyema combined with a malignancy, such as lymphoma or a soft tissue sarcoma. The tumor, which was classified as an encapsulated chronic hematoma, was removed surgically. Samples sent for histopathological and microbiological analysis revealed no evidence of neoplasia or infection. The patient was finally diagnosed with a chronic expanding hematoma of the thorax. This case is particularly rare due to the patient's development of a very large mass after undergoing treatment for tuberculosis more than 30 years earlier.
Tomography, X-Ray Computed ; Radiography, Thoracic ; Positron-Emission Tomography ; Pleural Cavity/*pathology/radiography/radionuclide imaging ; Male ; Humans ; Hematoma/*pathology/radiography/radionuclide imaging ; Dyspnea/etiology ; Chronic Disease ; Aged

Spontaneous intrahepatic bleeding is a rare condition. In the absence of trauma, intrahepatic hematoma may be due to underlying liver disease. We report a case of hepatocellular carcinoma in the patient who had huge intrahepatic hematoma without definite intrahepatic tumor at the time of initial presentation. A 54-year-old man was admitted to our hospital with a sudden onset of upper abdominal pain. Initial abdominal CT scan showed huge hematoma measuring more than 13 cm in diameter in the right lobe of the liver. However, there was no enhancing lesion in the liver. Laboratory data showed high alanine aminotransferase, alpha-fetoprotein and positive HBsAg. The MRI and angiography could not also depict any mass in the liver. The patient was treated with percutaneous drainage on the intrahepatic hematoma. The cytology from drainaged blood revealed no malignant cell. After hematoma decreased, follow-up CT scan depicted an enhancing tumor in the liver. He underwent right hepatic lobectomy and histopathological examination showed hepatocellular carcinoma.
Carcinoma, Hepatocellular/*diagnosis/pathology/surgery ; Hematoma/*diagnosis/etiology ; Humans ; Liver Diseases/*diagnosis/etiology ; Liver Neoplasms/*diagnosis/pathology/surgery ; Magnetic Resonance Angiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

Complications associated with an intramural hematoma of the bowel, is a relatively unusual condition. Most intramural hematomas resolve spontaneously with conservative treatment and the patient prognosis is good. However, if the symptoms are not resolved or the condition persists, surgical intervention may be necessary. Here we describe internal incision and drainage by endoscopy for the treatment of an intramural hematoma of the duodenum. A 63-yr-old woman was admitted to the hospital with hematemesis. The esophagogastroduodenoscopy (EGD) showed active ulcer bleeding at the distal portion of duodenal bulb. A total of 10 mL of 0.2% epinephrine and 2 mL of fibrin glue were injected locally. The patient developed diffuse abdominal pain and projectile vomiting three days after the endoscopic treatment. An abdominal computed tomography revealed a very large hematoma at the lateral duodenal wall, approximately 10X5 cm in diameter. Follow-up EGD was performed showing complete luminal obstruction at the second portion of the duodenum caused by an intramural hematoma. The patient's condition was not improved with conservative treatment. Therefore, 21 days after admission, endoscopic treatment of the hematoma was attempted. Puncture and incision were performed with an electrical needle knife. Two days after the procedure, the patient was tolerating a soft diet without complaints of abdominal pain or vomiting. The hematoma resolved completely on the follow-up studies.
Drainage ; Duodenal Diseases/*diagnosis/pathology/surgery ; Endoscopy, Digestive System ; Female ; Gastrointestinal Hemorrhage/*etiology/therapy ; Hematoma/*diagnosis/pathology/surgery ; Humans ; Intestinal Obstruction/*etiology/therapy ; Middle Aged ; Tomography, X-Ray Computed