Giant chronic expanding hematoma in the chest identified 25 years after a blunt chest trauma

Abstract

We herein report the case of a 42-year-old man who presented with a huge intrathoracic mass that had grown over a period of 25 years. The initial symptom caused by the mass was dull pain in the chest. T2-weighted magnetic resonance imaging revealed a mosaic pattern of various signal intensities, indicating a chronic expanding hematoma. The mass was completely resected surgically. For patients who present with a slowly growing mass, particularly those with a history of tuberculous pleuritis, chest surgery or trauma, a chronic expanding hematoma should be taken into consideration. Surgical resection is the first choice of treatment for a chronic expanding hematoma caused by a blunt chest trauma.

Keywords: chest injury; chronic expanding hematoma; diagnosis; surgery.

Figure 1.

(A and B) Chest computed tomography scan revealed a huge intrathoracic mass and moderate pleural effusion in the left pleural cavity. (C) T2-weighted magnetic resonance imaging demonstrated a huge well-defined mass with a mixture of high- and low-signal intensity areas in the chest. (D) T1-weighted images showed a mass with a mildly high signal intensity in the left anterior pericardium.

Figure 2.

(A-C) On macroscopic examination, the resected mass had a dense fibrous capsule, which was filled with hemorrhagic material and necrotic tissue. (D) Histological analysis revealed an old hematoma surrounded by fibrous tissue, with dilated microvessels and blood stasis within the hematoma.