A 49-year-old man with no past medical history presented to the Emergency Department with right lower extremity pain and swelling following recent trauma.
CT evaluation without contrast showed a mass, which was described as a large hematoma. Given the size and symptoms, mostly pain, surgery was performed and the hematoma was evacuated.
Follow-up CT two months later demonstrated apparent recurrence of hematoma. Surgery was again performed, but a tissue sample was obtained and sent for pathologic evaluation, which revealed pleomorphic sarcoma.
Necrosis seen in sarcoma may mimic the appearance of blood in hematoma, both on imaging and gross examination, if hematoma evacuation is performed.
Educational Goals / Teaching Points
Differentiating hematoma from sarcoma is crucial, especially when discovered incidentally in the setting of acute trauma.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Intramuscular hematoma is a common finding seen in the setting of trauma, often presenting as a heterogeneous mass on computed tomography (CT). Sometimes, failure to consider other differential diagnosis may lead to delay in diagnosis of more devastating pathologies, such as malignant masses including sarcoma.
Sarcomas may mimic a persistent or recurrent hematoma. Non-resolution on follow-up imaging raises the suspicion for tumor. The preferred evaluation method is contrast enhanced MRI or CT. If surgery is performed to evacuate a hematoma, early tissue sampling is crucial for better prognostic outcomes.