A Case Report of Chronic Expanding Hematoma of the Left Erector Spinae Muscle After Stereotactic Body Radiotherapy for Renal Cell Carcinoma

Background: Hematomas that slowly increase in size for over a period of more than one month after the initial hemorrhage are referred to as chronic expanding hematoma (CEH). We report a case of CEH of left erector spinae muscle after stereotactic body radiotherapy (SBRT) for renal cell carcinoma (RCC). Case presentation: A 74-year-old Japanese male complained of back pain. There was no history of surgery or trauma of his back. He received SBRT for RCC of left kidney of seven years ago. Computed tomography (CT) revealed the left erector spinae muscle was swollen compared to the contralateral side at the third lumbar level. Ultrasonography showed a tumor of 30 mm in size without blood flow in left paraspinal muscle. Positron emission tomography-CT revealed uptake in the left paraspinal muscle. Pathological examination showed radiation-induced CEH. We performed conservative therapy with medication alone because the tumor had been gradually growing. One year after starting observation, the patient died due to subdural hemorrhage after a fall and progression of renal failure. Discussion and conclusions: Because this study was a case study, it is difficult to definite the CEH after SBRT. Since SBRT has recently been increasing, SBRT-induced CEH is considered to be an important complication.

Subcapsular hepatic hematoma: a case of chronic expanding hematoma of the liver

Background A chronic expanding hematoma (CEH) enlarges as a result of slight bleeding over several months, and the tissue shows a mixture of blood breakdown products, granulation tissue with capillary ingrowth, and inflammatory tissue. This report presents a case of a subcapsular hepatic CEH that was treated with transarterial embolization (TAE) and hepatectomy. Case presentation A 56-year-old man presented with vomiting and right-sided abdominal pain. Plain abdominal computed tomography (CT) showed a high-density area of fluid collection beneath the capsule of the right hepatic lobe, which was diagnosed as a hematoma. From its anatomical position on the CT images, a subcapsular hepatic hematoma was diagnosed. Though conservative therapy was provided, CT-guided percutaneous drainage and TAE were performed due to worsening symptom. Because the patient's abdominal symptoms re-appeared, extended right segmentectomy including the hematoma was performed. In the resected specimen, the hematoma was located beneath the capsule of the right hepatic lobe, and it was displacing the hepatic parenchyma. Microscopic examination showed a thick fibrous capsule around the hematoma, peripheral lymphocyte and plasmacyte invasion, and aggregations of histiocytes containing phagocytosed hemosiderin. Conclusions Anatomically, this was a case of a subcapsular hepatic hematoma, and pathologically it was shown to be a CEH. Complete surgical resection was effective treatment for this CEH.

Superior Vena Cava Syndrome due to pericardial hematoma: A case report and mini-review of literature

Superior vena cava syndrome is a life-threatening condition. Typically, the clinical presentations are gradual; hence, the diagnosis is often delayed until critical compression or obstruction has occurred. Pericardial hematoma is a rare condition that could occur after cardiac surgery. An asymptomatic, 25-year-old female, who underwent surgical atrial septal defect closure 5 days ago, was sent for routine echocardiography examination before discharge. An intrapericardiac hematoma was detected at the right atrium’s free wall without any intracardiac hemodynamic consequences. The patient was discharged and planned for monthly evaluation. During follow-up, the intrapericardiac hematoma was expanding. In the third month’s follow-up, the patient complained of shortness of breath, headaches, and coughs. Echocardiography evaluation revealed enlarged pericardial hematoma, which compressed the right atrium and superior vena cava orifice, without echo’ sign of cardiac tamponade. Computed tomography scan revealed superior vena cava compression by the pericardial hematoma and appearance of the collateral vessel. The patient was diagnosed with superior vena cava syndrome and sent for surgical evacuation. Pericardial hematoma after cardiac surgery should be evaluated meticulously. Chronic expanding hematoma could cause superior vena cava syndrome, which is fatal. Early diagnosis and appropriate treatment are essential in managing this condition.