Temporal Evolution of a Chronic Expanding Organizing Hematoma on MRI, Including Functional MR Imaging Techniques: a Case Report

Chronic expanding organizing hematoma (CEH) occasionally mimics a soft tissue tumor on MRI, which becomes more problematic in patients with a history of surgical resection for musculoskeletal malignancy. Herein, we present a case of CEH which we were able to differentiate from recurrent tumor through MRI follow-up, including diffusion-weighted imaging (DWI) and dynamic contrast enhanced (DCE) imaging. A 66-year-old male visited our institution under suspicion of recurrent leiomyosarcoma of the thigh, 19 months after surgery and radiation therapy. Due to inconclusive results, three US-guided biopsies and 6 MRI examinations were performed over 2 years. In the end, we could diagnose a CEH using conventional and functional MRI techniques, and it was histopathologically confirmed after surgical resection. A CEH may occur remotely after an initiating event, and it may persist and expand over several years. Functional MR sequences, in addition to conventional sequences, are helpful in differentiating CEH from malignant neoplasms.

A Case of Surgical Management for Orbital Organizing Hematoma from Orbital Varix

PURPOSE: Orbital varices, which can lead to proptosis or globe displacement, are caused by Valsalva's maneuver or bending forward. Most of the orbital varices are treated conservatively, but surgical treatment is necessary for severe cosmetic or functional problems. We report a case of orbital organizing hematoma accompanied by an orbital varix which was successfully removed surgically without complications such as intraoperative bleeding. CASE SUMMARY: A 78-year-old female presented with the complaint of 4 mm proptosis and hyperglobus of left eye. Orbit magnetic resonance imaging (MRI) showed a well demarcated extraconal mass in the inferior orbit which appeared to be an orbital varix. Initially, we decided to monitor the patient without surgery because proptosis was reduced to 1 mm within a week. However, after 5 months, the symptoms suddenly worsened, specifically, 4 mm of proptosis with severe hyperglobus and pain. MRI showed a 29.7 x 21.2 x 23.7 mm mass compressing the globe upward. Six weeks of conservative care did not improve the symptoms and we eventually performed an anterior orbitotomy through the inferior conjunctiva. There was a minor bleeding during the surgery. Based on the histological test, the mass was determined to be an organizing hematoma covered by a membrane. At 8 months postoperatively, symptoms had not recurred. CONCLUSIONS: Orbital varices are usually treated conservatively since its surgical removal is known to have risks. Nonetheless, if an MRI shows an orbital organizing hematoma, it can be surgically debulked successfully without complications when a chronic hemorrhage from orbital varix causes serious proptosis and globe deviation.

A Case of Orbital Organizing Hematoma Presenting as a Chalazion

PURPOSE: Organizing hematomas (hematic pseudocysts) of the orbit are usually the consequence of direct blunt trauma and are important in the differential diagnosis of orbital cystic lesion. Herein, we report a case of orbital organizing hematoma masquerading as a chalazion. CASE SUMMARY: A 12-year-old female visited our clinic complaining of left lower eyelid swelling. CT scan and MR imaging showed a mass detected in the inferomedial space of her left orbit, which did not invade the adjacent tissue. Excisional biopsy of the orbital mass was performed. Histological examination showed the accumulation of blood-breakdown products within a thick fibrous capsule without epithelial or endothelial lining. The mass was diagnosed as an organizing hematoma. CONCLUSIONS: An orbital organizing hematoma can present, although rare, as a chalazion-like eyelid mass. Careful clinical and radiological examinations can help in making a differential diagnosis.

A Case of Organizing Hematoma of the Nasal Septum / 대한이비인후과학회지

Organizing hematomas are rare benign tumors and appear as forms of mass which is composed of neovascularization with organizing fibrous tissue in hematoma. There have been sporadic reports of the organizing hematoma not only in soft tissue but also in brain, spinal cord, lung, and maxillary sinus. We report a case of organizing hematoma that was restricted in the nasal cavity without inclusion of the paranasal sinus. This is the first article describing the organizing hematoma of the nasal septum. We present this case with a review of literature.

Non-Traumatic Organizing Hematoma on Supraclavicular Fossa in a Child: A Case Report / 대한이비인후과학회지

Organizing hematoma occurs in many locations and simulate neoplasms. They have similar histologic features such as having a central mass of blood, granulation tissue, and dense, fibrous tissue at the periphery. There have been sporadic reports of organizing hematoma found not only in the soft tissue but also in the brain, adrenal gland, lung and maxillary sinus. We report a case of nontraumatic organizing hematoma encountered in a child -on the supraclavicular fossa. To our knowledge it is a site that has not been previously reported.

Organizing Hematoma of the Maxillary Sinus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Organizing hematoma of the maxillary sinus can be developed by organizing procedure of hematoma in the unaerated maxillary sinus. To our knowledge, this is the second article describing organizing hematoma in the maxillary sinus. We experienced 7 cases recently, and aimed to describe clinical features, radiologic characteristics, and pathological findings. MATERIALS AND METHODS: Seven patients were diagnosed as organizing hematoma pathologically. We reviewed computed tomography (CT) and medical records to find out clinical features of organizing hematoma of the maxillary sinus. Of seven patients, five were male and two were female. Their mean age was 49 years. RESULTS: All patients had a history of frequent epistaxis without bleeding tendency. They also complained of nasal obstruction, hyposmia, headache, and cheek swelling. Rhinoscopy revealed obliterated nasal cavity due to bulging lateral wall. CT scans showed soft-tissue densities expanding the maxillary sinus with the minimal contrast enhancement. Destruction of the bony wall was observed in two patients. Endoscopic sinus surgery, Caldwell-Luc's operation, and Denker's operation were applied for the treatment singly or in combination, and resulted in successful outcome. CONCLUSION: Organizing hematoma should be included in the differential diagnosis when patients have frequent epistaxis and expansile lesion in the maxillary sinus.