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Musculoskeletal
Diagnosis
Trauma
Traumatic Injury, Special Topics
Hematoma
Hematoma
Kirkland W. Davis, MD, FACR; Andrew Sonin, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Hematoma: Localized collection of blood (usually clotted) outside blood vessel but contained within space
              • Interstitial hemorrhage: Blood interspersed within muscle

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Angiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Lutterbach-Penna RA et al: Ultrasound of the thigh: focal, compartmental, or comprehensive examination? AJR Am J Roentgenol. 203(5):1085-92, 2014
                                              2. Hayashi D et al: Traumatic injuries of thigh and calf muscles in athletes: role and clinical relevance of MR imaging and ultrasound. Insights Imaging. 3(6):591-601, 2012
                                              3. Lee JC et al: Imaging of muscle injury in the elite athlete. Br J Radiol. 85(1016):1173-85, 2012
                                              4. Negoro K et al: Chronic expanding hematoma of the thigh. Joint Bone Spine. 79(2):192-4, 2012
                                              5. Blankenbaker DG et al: Temporal changes of muscle injury. Semin Musculoskelet Radiol. 14(2):176-93, 2010
                                              6. Kontogeorgakos VA et al: Extremity soft tissue sarcomas presented as hematomas. Arch Orthop Trauma Surg. 130(10):1209-14, 2010
                                              7. McKenzie G et al: Pictorial review: Non-neoplastic soft-tissue masses. Br J Radiol. 82(981):775-85, 2009
                                              8. Shelly MJ et al: MR imaging of muscle injury. Magn Reson Imaging Clin N Am. 17(4):757-73, vii, 2009
                                              9. Taïeb S et al: Soft tissue sarcomas or intramuscular haematomas? Eur J Radiol. 72(1):44-9, 2009
                                              10. Wu JS et al: Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 253(2):297-316, 2009
                                              11. Nett MP et al: Magnetic resonance imaging of acute "wiiitis" of the upper extremity. Skeletal Radiol. 37(5):481-3, 2008
                                              12. Theodorou SJ et al: Imaging findings of complications affecting the upper extremity in intravenous drug users: featured cases. Emerg Radiol. 15(4):227-39, 2008
                                              13. Allen DJ et al: Primary malignancies mistaken for pseudotumours in haemophilic patients. Haemophilia. 13(4):383-6, 2007
                                              14. Papp DF et al: Magnetic resonance imaging of soft-tissue tumors: determinate and indeterminate lesions. J Bone Joint Surg Am. 89 Suppl 3:103-15, 2007
                                              15. Elsayes KM et al: Value of magnetic resonance imaging in muscle trauma. Curr Probl Diagn Radiol. 35(5):206-12, 2006
                                              16. Liu PT et al: Chronic expanding hematoma of the thigh simulating neoplasm on gadolinium-enhanced MRI. Skeletal Radiol. 35(4):254-7, 2006
                                              17. Mann HA et al: Synovial Sarcoma Mimicking Haemophilic Pseudotumour. Sarcoma. 2006
                                              18. Niimi R et al: Soft-tissue sarcoma mimicking large haematoma: a report of two cases and review of the literature. J Orthop Surg (Hong Kong). 14(1):90-5, 2006
                                              19. Rajapakse BN et al: Calcifying haematoma mimicking a soft tissue sarcoma and myositis ossificans. ANZ J Surg. 76(11):1027-9, 2006
                                              20. Suzuki T et al: Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma. Injury. 36(1):151-9, 2005
                                              21. Connell DA et al: Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol. 183(4):975-84, 2004
                                              22. Gilbert BC et al: MRI of a Morel-Lavellée lesion. AJR Am J Roentgenol. 182(5):1347-8, 2004
                                              23. Gomez P et al: High-grade sarcomas mimicking traumatic intramuscular hematomas: a report of three cases. Iowa Orthop J. 24:106-10, 2004
                                              24. Mahevas M et al: [Muscular haematoma in Henoch-Schonlein purpura] Rev Med Interne. 25(12):927-30, 2004
                                              25. Saotome K et al: Enlarging intramuscular hematoma and fibrinolytic parameters. J Orthop Sci. 8(2):132-6, 2003
                                              26. Krebs M et al: Massive postoperative intramuscular bleeding in acquired von Willebrand's disease. Ann Hematol. 81(7):394-6, 2002
                                              27. Bush CH: The magnetic resonance imaging of musculoskeletal hemorrhage. Skeletal Radiol. 29(1):1-9, 2000
                                              28. Aoki T et al: The radiological findings in chronic expanding hematoma. Skeletal Radiol. 28(7):396-401, 1999
                                              29. Clanton TO et al: Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. 6(4):237-48, 1998
                                              30. Lin WY et al: Subcutaneous hematoma detected on Tc-99m pyrophosphate muscle imaging. Clin Nucl Med. 23(1):56, 1998
                                              31. Jaovisidha S et al: Hemophilic pseudotumor: spectrum of MR findings. Skeletal Radiol. 26(8):468-74, 1997
                                              32. Takebayashi S et al: Sonographic findings in muscle strain injury: clinical and MR imaging correlation. J Ultrasound Med. 14(12):899-905, 1995
                                              33. Bradley WG Jr: MR appearance of hemorrhage in the brain. Radiology. 189(1):15-26, 1993
                                              34. Mittlmeier T et al: Compartment syndrome of the foot after intraarticular calcaneal fracture. Clin Orthop Relat Res. (269):241-8, 1991
                                              35. De Smet AA et al: Magnetic resonance imaging of muscle tears. Skeletal Radiol. 19(4):283-6, 1990
                                              36. Niemi P et al: MR imaging of experimental intramuscular hemorrhage at 0.02 T. Contrast enhancement with Gd-DOTA. Acta Radiol. 31(5):455-8, 1990
                                              37. Wilson DA et al: MR imaging of hemophilic pseudotumors. AJR Am J Roentgenol. 150(2):349-50, 1988
                                              38. Pakter RL et al: Calf hematoma--computed tomographic and magnetic resonance findings. Skeletal Radiol. 16(5):393-6, 1987
                                              39. Rubin JI et al: High-field MR imaging of extracranial hematomas. AJR Am J Roentgenol. 148(4):813-7, 1987
                                              40. Dooms GC et al: MR imaging of intramuscular hemorrhage. J Comput Assist Tomogr. 9(5):908-13, 1985
                                              41. Heiken JP et al: CT of benign soft-tissue masses of the extremities. AJR Am J Roentgenol. 142(3):575-80, 1984
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Diagnostic Checklist

                                                        TERMINOLOGY

                                                        • Definitions

                                                          • Hematoma: Localized collection of blood (usually clotted) outside blood vessel but contained within space
                                                          • Interstitial hemorrhage: Blood interspersed within muscle

                                                        IMAGING

                                                        • General Features

                                                          • Radiographic Findings

                                                            • CT Findings

                                                              • MR Findings

                                                                • Ultrasonographic Findings

                                                                  • Angiographic Findings

                                                                    • Imaging Recommendations

                                                                      DIFFERENTIAL DIAGNOSIS

                                                                        PATHOLOGY

                                                                        • General Features

                                                                          • Gross Pathologic & Surgical Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Lutterbach-Penna RA et al: Ultrasound of the thigh: focal, compartmental, or comprehensive examination? AJR Am J Roentgenol. 203(5):1085-92, 2014
                                                                                          2. Hayashi D et al: Traumatic injuries of thigh and calf muscles in athletes: role and clinical relevance of MR imaging and ultrasound. Insights Imaging. 3(6):591-601, 2012
                                                                                          3. Lee JC et al: Imaging of muscle injury in the elite athlete. Br J Radiol. 85(1016):1173-85, 2012
                                                                                          4. Negoro K et al: Chronic expanding hematoma of the thigh. Joint Bone Spine. 79(2):192-4, 2012
                                                                                          5. Blankenbaker DG et al: Temporal changes of muscle injury. Semin Musculoskelet Radiol. 14(2):176-93, 2010
                                                                                          6. Kontogeorgakos VA et al: Extremity soft tissue sarcomas presented as hematomas. Arch Orthop Trauma Surg. 130(10):1209-14, 2010
                                                                                          7. McKenzie G et al: Pictorial review: Non-neoplastic soft-tissue masses. Br J Radiol. 82(981):775-85, 2009
                                                                                          8. Shelly MJ et al: MR imaging of muscle injury. Magn Reson Imaging Clin N Am. 17(4):757-73, vii, 2009
                                                                                          9. Taïeb S et al: Soft tissue sarcomas or intramuscular haematomas? Eur J Radiol. 72(1):44-9, 2009
                                                                                          10. Wu JS et al: Soft-tissue tumors and tumorlike lesions: a systematic imaging approach. Radiology. 253(2):297-316, 2009
                                                                                          11. Nett MP et al: Magnetic resonance imaging of acute "wiiitis" of the upper extremity. Skeletal Radiol. 37(5):481-3, 2008
                                                                                          12. Theodorou SJ et al: Imaging findings of complications affecting the upper extremity in intravenous drug users: featured cases. Emerg Radiol. 15(4):227-39, 2008
                                                                                          13. Allen DJ et al: Primary malignancies mistaken for pseudotumours in haemophilic patients. Haemophilia. 13(4):383-6, 2007
                                                                                          14. Papp DF et al: Magnetic resonance imaging of soft-tissue tumors: determinate and indeterminate lesions. J Bone Joint Surg Am. 89 Suppl 3:103-15, 2007
                                                                                          15. Elsayes KM et al: Value of magnetic resonance imaging in muscle trauma. Curr Probl Diagn Radiol. 35(5):206-12, 2006
                                                                                          16. Liu PT et al: Chronic expanding hematoma of the thigh simulating neoplasm on gadolinium-enhanced MRI. Skeletal Radiol. 35(4):254-7, 2006
                                                                                          17. Mann HA et al: Synovial Sarcoma Mimicking Haemophilic Pseudotumour. Sarcoma. 2006
                                                                                          18. Niimi R et al: Soft-tissue sarcoma mimicking large haematoma: a report of two cases and review of the literature. J Orthop Surg (Hong Kong). 14(1):90-5, 2006
                                                                                          19. Rajapakse BN et al: Calcifying haematoma mimicking a soft tissue sarcoma and myositis ossificans. ANZ J Surg. 76(11):1027-9, 2006
                                                                                          20. Suzuki T et al: Arterial injury associated with acute compartment syndrome of the thigh following blunt trauma. Injury. 36(1):151-9, 2005
                                                                                          21. Connell DA et al: Longitudinal study comparing sonographic and MRI assessments of acute and healing hamstring injuries. AJR Am J Roentgenol. 183(4):975-84, 2004
                                                                                          22. Gilbert BC et al: MRI of a Morel-Lavellée lesion. AJR Am J Roentgenol. 182(5):1347-8, 2004
                                                                                          23. Gomez P et al: High-grade sarcomas mimicking traumatic intramuscular hematomas: a report of three cases. Iowa Orthop J. 24:106-10, 2004
                                                                                          24. Mahevas M et al: [Muscular haematoma in Henoch-Schonlein purpura] Rev Med Interne. 25(12):927-30, 2004
                                                                                          25. Saotome K et al: Enlarging intramuscular hematoma and fibrinolytic parameters. J Orthop Sci. 8(2):132-6, 2003
                                                                                          26. Krebs M et al: Massive postoperative intramuscular bleeding in acquired von Willebrand's disease. Ann Hematol. 81(7):394-6, 2002
                                                                                          27. Bush CH: The magnetic resonance imaging of musculoskeletal hemorrhage. Skeletal Radiol. 29(1):1-9, 2000
                                                                                          28. Aoki T et al: The radiological findings in chronic expanding hematoma. Skeletal Radiol. 28(7):396-401, 1999
                                                                                          29. Clanton TO et al: Hamstring strains in athletes: diagnosis and treatment. J Am Acad Orthop Surg. 6(4):237-48, 1998
                                                                                          30. Lin WY et al: Subcutaneous hematoma detected on Tc-99m pyrophosphate muscle imaging. Clin Nucl Med. 23(1):56, 1998
                                                                                          31. Jaovisidha S et al: Hemophilic pseudotumor: spectrum of MR findings. Skeletal Radiol. 26(8):468-74, 1997
                                                                                          32. Takebayashi S et al: Sonographic findings in muscle strain injury: clinical and MR imaging correlation. J Ultrasound Med. 14(12):899-905, 1995
                                                                                          33. Bradley WG Jr: MR appearance of hemorrhage in the brain. Radiology. 189(1):15-26, 1993
                                                                                          34. Mittlmeier T et al: Compartment syndrome of the foot after intraarticular calcaneal fracture. Clin Orthop Relat Res. (269):241-8, 1991
                                                                                          35. De Smet AA et al: Magnetic resonance imaging of muscle tears. Skeletal Radiol. 19(4):283-6, 1990
                                                                                          36. Niemi P et al: MR imaging of experimental intramuscular hemorrhage at 0.02 T. Contrast enhancement with Gd-DOTA. Acta Radiol. 31(5):455-8, 1990
                                                                                          37. Wilson DA et al: MR imaging of hemophilic pseudotumors. AJR Am J Roentgenol. 150(2):349-50, 1988
                                                                                          38. Pakter RL et al: Calf hematoma--computed tomographic and magnetic resonance findings. Skeletal Radiol. 16(5):393-6, 1987
                                                                                          39. Rubin JI et al: High-field MR imaging of extracranial hematomas. AJR Am J Roentgenol. 148(4):813-7, 1987
                                                                                          40. Dooms GC et al: MR imaging of intramuscular hemorrhage. J Comput Assist Tomogr. 9(5):908-13, 1985
                                                                                          41. Heiken JP et al: CT of benign soft-tissue masses of the extremities. AJR Am J Roentgenol. 142(3):575-80, 1984
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