Investig Magn Reson Imaging.  2017 Mar;21(1):43-50. 10.13104/imri.2017.21.1.43.

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

• Lee J
• Lee T
• Oh E
• Yoon YC

• KMID: 2376269
• DOI: http://doi.org/10.13104/imri.2017.21.1.43

Abstract

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.

Keyword

Chronic expanding organizing hematoma; MRI; Functional MRI; Diffusion-weighted imaging (DWI); Dynamic contrast enhanced (DCE) imaging

MeSH Terms

Aged
Biopsy
Follow-Up Studies
Hematoma*
Humans
Leiomyosarcoma
Magnetic Resonance Imaging*
Male
Thigh

Figure

• 

  Fig. 1 Overview of the patient's clinical course. CEH = chronic expanding organizing hematoma; Chr. infl. = chronic inflammation; Inc size = increased size; M = month; US-Bx = US-guided biopsy; W = week

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  Fig. 2 Initial MRI obtained at the previous hospital. T1-weighted image (a), T2-weighted image (b), and T1-weighted contrast-enhanced image (c). There is a well-circumscribed mass with lobulated contours in the mid-thigh. The pathologic diagnosis was leiomyosarcoma.

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  Fig. 3 Second MRI obtained at our institute. T1-weighted image (a), T2-weighted image (b), T1-weighted contrast-enhanced image (c), apparent diffusion coefficient (ADC) map (d), and PET-CT obtained two weeks before (e). An enhancing nodular lesion in the operative bed is seen. This lesion shows an increase in size, compared to the previous MRI examination (not shown). The ADC map does not show diffusion restriction.

• 

  Fig. 4 Sixth (last) MRI obtained at our institute. T1-weighted image (a), T2-weighted image (b), T1-weighted contrast-enhanced image (c), apparent diffusion coefficient (ADC) map (d), and dynamic enhancement curve (e). The growing mass now shows a distinct hypointense rim on T2-weighted images, which is a characteristic finding of chronic expanding organizing hematoma. The high ADC value and non-arterial enhancement curve favor benignity.

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  Fig. 5 Low-power microscopic photograph of the surgical specimen. There is chronic inflammation and granulation tissue, with a surrounding thick fibrous capsule. Fibrinous exudates with hemorrhage, dilated vessels, and neovascularization were seen within the lesion. Pathology report confirmed the diagnosis of chronic expanding organizing hematoma.

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