571129
research-article2015
IJLXXX10.1177/1534734615571129The International Journal of Lower Extremity WoundsWollina et al
Case Report
Chronic Expanding Organized Hematoma of the Lower Leg: A Rare Cause for Nonhealing Leg Ulcers
The International Journal of Lower Extremity Wounds 1–4 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1534734615571129 ijl.sagepub.com
Uwe Wollina, MD1, Birgit Heinig, Dipl-Med1, and Dana Langner, FA1
Abstract Chronic expanding hematoma is a rare entity on the leg. A 55-year-old women presented with 2 small nonhealing leg ulcers. On examination we observed a painless bulky tumor-like mass that developed slowly after deep soft tissue infection almost 2 years ago. Vascular computed tomography suggested an organized hematoma. Important differential diagnoses include sarcoma and lymphoma. Treatment of choice is surgery. Histology confirmed the diagnosis of an organized hematoma. Chronic expanding hematoma is a rare cause of nonhealing leg ulcers. Keywords soft tissue infection, leg ulcers, chronic expanding hematoma, organized hematoma
Introduction Skin and soft tissue infections are common. Surgical drainage, debridement, and appropriate antibiotic therapy are the mainstays in their treatment. The leading diagnosis is erysipelas/cellulitis. Erysipelas can be complicated by necrosis and ulceration, gangrenous variants, abscess formation, phlebitis, thrombosis, and hematoma.1 Obesity has been identified as a major risk factor for complicating erysipelas.2 Organized hematoma can develop after trauma, infection, and association with malignancies that cause bleedings. They impose at bulky mass without specific clinical symptoms. Imaging technique, in particular vascular computed tomography (CT) and magnetic resonance imaging (MRI), help differentiate organized hematoma from tumors.3,4 Chronic expanding hematoma is considered to be a special entity.5 Chronic expanding and organized hematomas of the leg has been rarely reported. The treatment of choice is complete surgical removal.6
Case Report A 55-year-old female obese patient (body mass index 34) presented with nonhealing pretibial ulcers of the right lower leg (Figure 1). She suffered from chronic venous insufficiency, hypertension, and hyperuricemia. Her medical history was remarkable for deep soft tissue infection (gangrenous erysipelas) in January 2013. On examination we observed 2
small superficial leg ulcers pretibial (maximum diameter 3.5 cm) on the right lower leg and a medial subcutaneous tumor-like bulky mass with superficial tissue fibrosis and hemosiderosis (Figure 2). The left leg had varicose veins but no ulcers or subcutaneous swelling at all. After request the patient told us that this lesion on her right lower leg had started in February 2013 with a slowly progressing swelling. The lesion itself was painless. The ulcers had developed 2 months after the swelling was noted. Both Duplex ultrasound and ankle–brachial pressure index/ankle–brachial index tests had already been performed in the outpatient setting elsewhere without any evidence for peripheral arterial disease. A vascular CT identified a round-shaped lesion on the fascia cruris without vascular enhancement or osseous destruction. Its diameter was 5.2 cm. A number of varicose veins were localized around the lesion. Subcutaneous adipose tissue demonstrated signs of marked induration (Figure 3). Laboratory investigations demonstrated increased percentage of hypochromic erythrocytes (14.3%; normal range
research-article2015
IJLXXX10.1177/1534734615571129The International Journal of Lower Extremity WoundsWollina et al
Case Report
Chronic Expanding Organized Hematoma of the Lower Leg: A Rare Cause for Nonhealing Leg Ulcers
The International Journal of Lower Extremity Wounds 1–4 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1534734615571129 ijl.sagepub.com
Uwe Wollina, MD1, Birgit Heinig, Dipl-Med1, and Dana Langner, FA1
Abstract Chronic expanding hematoma is a rare entity on the leg. A 55-year-old women presented with 2 small nonhealing leg ulcers. On examination we observed a painless bulky tumor-like mass that developed slowly after deep soft tissue infection almost 2 years ago. Vascular computed tomography suggested an organized hematoma. Important differential diagnoses include sarcoma and lymphoma. Treatment of choice is surgery. Histology confirmed the diagnosis of an organized hematoma. Chronic expanding hematoma is a rare cause of nonhealing leg ulcers. Keywords soft tissue infection, leg ulcers, chronic expanding hematoma, organized hematoma
Introduction Skin and soft tissue infections are common. Surgical drainage, debridement, and appropriate antibiotic therapy are the mainstays in their treatment. The leading diagnosis is erysipelas/cellulitis. Erysipelas can be complicated by necrosis and ulceration, gangrenous variants, abscess formation, phlebitis, thrombosis, and hematoma.1 Obesity has been identified as a major risk factor for complicating erysipelas.2 Organized hematoma can develop after trauma, infection, and association with malignancies that cause bleedings. They impose at bulky mass without specific clinical symptoms. Imaging technique, in particular vascular computed tomography (CT) and magnetic resonance imaging (MRI), help differentiate organized hematoma from tumors.3,4 Chronic expanding hematoma is considered to be a special entity.5 Chronic expanding and organized hematomas of the leg has been rarely reported. The treatment of choice is complete surgical removal.6
Case Report A 55-year-old female obese patient (body mass index 34) presented with nonhealing pretibial ulcers of the right lower leg (Figure 1). She suffered from chronic venous insufficiency, hypertension, and hyperuricemia. Her medical history was remarkable for deep soft tissue infection (gangrenous erysipelas) in January 2013. On examination we observed 2
small superficial leg ulcers pretibial (maximum diameter 3.5 cm) on the right lower leg and a medial subcutaneous tumor-like bulky mass with superficial tissue fibrosis and hemosiderosis (Figure 2). The left leg had varicose veins but no ulcers or subcutaneous swelling at all. After request the patient told us that this lesion on her right lower leg had started in February 2013 with a slowly progressing swelling. The lesion itself was painless. The ulcers had developed 2 months after the swelling was noted. Both Duplex ultrasound and ankle–brachial pressure index/ankle–brachial index tests had already been performed in the outpatient setting elsewhere without any evidence for peripheral arterial disease. A vascular CT identified a round-shaped lesion on the fascia cruris without vascular enhancement or osseous destruction. Its diameter was 5.2 cm. A number of varicose veins were localized around the lesion. Subcutaneous adipose tissue demonstrated signs of marked induration (Figure 3). Laboratory investigations demonstrated increased percentage of hypochromic erythrocytes (14.3%; normal range
