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Pitfalls in soft tissue sarcoma imaging: chronic expanding hematomas.

Kiarash Jahed1, Behnaz Khazai2, Monica Umpierrez1

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Chronic expanding hematomas (CEH) can mimic soft tissue sarcomas on MRI, leading to unnecessary biopsies or surgeries. Including CEH in the differential diagnosis is crucial for accurate patient management.

Keywords:
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Area of Science:

  • Radiology
  • Oncology
  • Pathology

Background:

  • Soft tissue sarcomas often present with solid or nodular enhancement on MRI, prompting specialist referral.
  • Heterogeneous enhancement and non-enhancing areas can also be seen in high-grade sarcomas or those with hemorrhage.

Observation:

  • This study presents multimodality imaging findings of chronic expanding hematomas (CEH) that mimicked sarcomas.
  • A comparison case of a non-enhancing CEH in the lower extremity is also discussed.

Findings:

  • Chronic expanding hematomas can exhibit imaging features indistinguishable from soft tissue sarcomas.
  • Image-guided biopsies of nodular tissue in CEH may yield benign results, which should not be dismissed.

Implications:

  • Considering CEH in the differential diagnosis for sarcoma-like masses can prevent unnecessary, morbid surgeries.
  • Accurate diagnosis of CEH may allow for conservative, noninvasive imaging follow-up instead of aggressive treatment.