Ultrasonography-Guided Muscle Hematoma Evacuation

Abstract

Muscle injuries commonly occur in athletes, and in severe cases, they can result in hematoma formation, leading to pain and loss of function. A technique for minimally invasive ultrasound-guided evacuation of muscle hematoma is presented. A simple and quick outpatient procedure done under local anesthesia for faster muscle recovery provided immediate decompression of the muscle compartment, leading to early return to play.

Fig 1

Preoperative ultrasound evaluation of the hematoma. The patient is placed in supine position and the ultrasound probe is placed on the anterolateral aspect of the left thigh. (A) The short-axis view on sonogram shows the hematoma between the rectus femoris (RF) and vastus intermedius (VI) with a diameter of 39.0 mm. (B) The long-axis view shows the hematoma with a diameter of 89.8 mm.

Fig 2

Postoperative ultrasound evaluation of the hematoma. (A) Short-axis view of residual hematoma (yellow arrows), rectus femoris (RF), and vastus intermedius (VI). Almost all of the hematoma was evacuated. (B) Long-axis view of residual hematoma (yellow arrows), RF, and VI. Almost all of the hematoma was evacuated.

Fig 3

Operative setting of ultrasonography-guided muscle hematoma evacuation. (A) Surgeon, ultrasound (US) probe, affected limb (left thigh), and US monitor were in line with each other. (B) The US probe (yellow square) was placed on the axial plane of the hematoma and rectus femoris (RF) and vastus intermedius (VI). This in-plane approach to the hematoma is easier because the needle (white arrow) can be visualized parallel with the US probe. (C) If the US probe (yellow square) is put on the sagittal plane of hematoma, RF and VI, visualization of the needle is more difficult because the needle is not parallel to the US probe.

Fig 4

Preparation of ultrasonography-guided muscle hematoma evacuation. (A) Local anesthesia on the right thigh is performed. The needle is visualized as it goes through the muscle. Rectus femoris (RF) and vastus intermedius (VI) muscles are shown. The optimal depth of the needle (white arrows) is determined on ultrasonography. (B) Infiltration of 2% xylocaine is done. (C) An incision of 1 cm in length and dilation with a mosquito clamp are performed after infiltration of the anesthetic.

Fig 5

Ultrasonography-guided muscle hematoma evacuation. (A) A shaver (white arrows) is introduced to the right thigh under ultrasound guidance to the center of the hematoma. The surrounding muscle tissues and neurovascular structures are avoided. (RF, rectus femoris; VI, vastus intermedius.) (B) The shaver is kept parallel to the US probe. (C) After removal of the hematoma at its center, the tip of the shaver as well as the US probe are synchronously brought to the peripheral part of the hematoma, and removal of the remaining hematoma is performed. A milking maneuver (yellow arrows) of the hematoma by an assistant is added to aid in the complete evacuation of the hematoma.