Iliac hematoma mimicking neoplasm in adolescent athletes

Abstract

Traumatic injuries of the hip and pelvis are common in child athletes and typically require minimal treatment. However, the presentation of such injuries can at times be clinically indistinguishable from the onset of a benign or malignant neoplastic process. In these circumstances, the orthopedic surgeon relies on modern diagnostic tools including imaging-predominantly magnetic resonance imaging (MRI) and computed tomography-and pathology studies. This article presents the cases of 2 adolescent boys with traumatic injuries to the hip, in which the threat of neoplasm could not be ruled out by in both initial imaging studies. In one case, biopsy could not conclusively rule out malignancy. In both cases, serial MRIs to monitor changes in lesion size proved valuable in determining treatment approach. The authors recommend a diagnostic algorithm to approach the differentiation of iliac hematoma from neoplasm and address the issue of waiting time in the diagnostic process. Early-and if necessary repeated-biopsy to rule out these conditions is advised, as conclusive pathologic findings are the only evidence that can rule out Ewing's sarcoma or an aneurysmal bone cyst. Given the morbidity of these conditions, the authors advocate this course of action to minimize distress to the patient and family members. Careful observation in combination with radiographic findings can yield a successful diagnosis, but the orthopedic surgeon must carefully weigh the increased risk of tumor growth against the need for biopsy.