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Hemophilic pseudotumor: spectrum of MR findings
S Jaovisidha1, K N Ryu, J Hodler
1Department of Radiology, Veterans Affairs Medical Center, San Diego, CA 92161, USA.
Objective:
To determine the MR imaging appearance of hemophilic pseudotumor (HP) and its clinical implications.
Design And Patients:
Five hemophilic patients (aged 35-77 years) with 12 HPs in various anatomic locations were included in this study. The MR images were retrospectively evaluated for the appearance of the lesions and accompanying abnormalities, as well as their clinical implications.
Results And Conclusion:
MR images of all five patients (12 lesions) showed well-defined masses containing blood clots in various stages of organization surrounded by a fibrous capsule in subcutaneous fat or in intramuscular, interfascial, subperiosteal, and intraosseous locations. Intramuscular HP frequently had mural nodules. This is an almost unique appearance that is somewhat unexpected. MR imaging allowed determination of number, size, and extent of the lesions, evidence of neurovascular involvement, and accompanying musculoskeletal alterations. It is concluded that MR imaging not only is a sensitive and accurate method for detecting and diagnosing HP and providing useful information for therapeutic decision making, but can also be used to assess results of treatment by allowing evaluation of the evolution of blood products, the size of lesions in regions difficult to access by physical examination, and recurrent bleeding within a chronic lesion.
Insights
Magnetic resonance imaging (MRI) reveals hemophilic pseudotumors (HP) as well-defined masses with organized blood clots and fibrous capsules. MRI is crucial for diagnosing HP, assessing its extent, and monitoring treatment effectiveness.
Area of Science:
- Radiology
- Hematology
- Orthopedics
Background:
- Hemophilic pseudotumor (HP) is a rare complication of hemophilia.
- Accurate diagnosis and assessment of HP are essential for effective management.
Purpose of the Study:
- To determine the MR imaging appearance of hemophilic pseudotumor (HP).
- To evaluate the clinical implications of HP identified via MR imaging.
Main Methods:
- Retrospective evaluation of MR images from five hemophilic patients with 12 HPs.
- Analysis of lesion appearance, accompanying abnormalities, and clinical implications.
Main Results:
- MR imaging demonstrated well-defined masses with organized blood clots and fibrous capsules in various locations.
- Intramuscular HPs often exhibited mural nodules, a distinctive feature.
- MRI accurately determined lesion number, size, extent, neurovascular involvement, and musculoskeletal alterations.
Conclusions:
- MR imaging is a sensitive and accurate method for detecting and diagnosing HP.
- MRI provides crucial information for therapeutic decision-making and treatment outcome assessment.
- MRI facilitates evaluation of blood product evolution, lesion size, and recurrent bleeding.