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Minerva Ortopedica e Traumatologica 2006 June;57(3):189-94


language: Italian

An intramuscular haemorrhagic mass is not always a post-trauma haematoma

Sacco F., Gino G. C., Faletti C., Pozza S., Boffano M., Mosetto F., Albertini U., Piana R., Forni M., Linari A., Comandone A., Brach del Prever E. M.

1 Dipartimento di Ortopedia e Traumatologia Unità Operativa Dipartimentale di Chirurgia Ortopedica Oncologica e Ricostruttiva, ASO CTO, CRF, MA, Torino 2 Dipartimento di Radiologia ASO CTO, CRF, MA, Torino 3 Servizio di Anatomia Patologica ASO OIRM, S. Anna, Torino 4 SCDO Oncologia Medica Ospedale Gradenigo, Torino


Although haematomas are frequent in traumatology and in patients with coagulation diseases, they are also a typical picture of high grade sarcomas; mis-diagnosis may lead to ineffective treatment. The aim of the study was to evaluate the diagnostic/therapeutic approach for an intramuscular haemorrhagic mass on 3 cases according to the Piedmont guidelines. Three patients with high-grade soft-tissue sarcoma had been initially treated for simple haematomas elsewhere and then referred to the UOD Oncology Orthopaedic and Reconstructive Surgery of ASO CTO, CRF, MA of Turin, Regional Reference Centre for Bone and Soft Tissue Sarcoma of Piedmont Oncologic Network. The diagnostic and therapeutic approach were analysed according to the Piedmont guidelines for soft tissue sarcoma. Average age was 64, no subjects were on drugs with coagulation interaction or had recent serious trauma; the first mis-diagnosis had been made on the basis of US (echography) elsewhere. The “haematomas” were treated with drainage and transversal cuts. The final diagnosis was fusocellular high grade sarcoma, treated with wide margins and limb sparing. The soft- tissue sarcoma, particularly if high grade and in older subjects, may simulate an haematoma. Whe-never there is a suspicious mass in a limb, it has to be studied with patient’s history, a clinical examination visit and, if necessary, US and X-ray. If the diagnosis is not clear, it is advisable to refer the subject to a specialized tumour centre.

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