Sarcoma the great "masquerader" hematoma/deep vein thrombosis manifestation. (2016)

• Record Type: Journal Article
• Authors: Valverde, J.; Vinagreiro, M.; Gouveia, P.; Koch, P.; Soares, V.; Gomes, T.
• Is Part Of: International journal of surgery case reports. Volume 28(2016)
• Page Start: 348
• Page End: 351
• Publication Date: 2016
• Subjects: Hematoma -- Deep vein thrombosis -- Thigh mass -- Sarcoma; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2016.10.041
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: The clinical presentation of patients with soft-tissue sarcoma is highly variable. A mass over 5 cm in size arising beneath the level of deep fascia should be considered a sarcoma. MRI is the imaging exam of choice when evaluating a mass of the extremities. An early diagnosis of sarcoma, a great masquerader requires a clinically suspicious doctor. Abstract: Introduction: The clinical presentation of patients with soft-tissue sarcoma is highly variable. Most patients present with a painless mass, typically one that is increasing in size, and few have systemic symptoms such as fever, weight loss, or malaise. Soft tissue sarcomas can initially present as, or even be misdiagnosed as, deep venous thrombosis (DVT), leading to a late diagnosis. Case report: A 51-year-old woman presented to the hospital with complaints of pain and swelling in her left thigh, interpreted as an infected hematoma with an associated deep vein thrombosis and treated accordingly. The patient presented to our emergency department two more times. In the last visit and due to an unresolving clinical scenario a MRI and surgical byopsies were made that confirmed a sarcoma diagnosis. Discussion: When a patient presents with an expanding, nontraumatic mass simulating a haematoma, several other differential diagnoses should be considered including aneurysm, bleeding tendency, chronic expanding haematoma and soft-tissue sarcoma. The growth of the tumor undetected while being treated for the DVT and then posteriorly for the hematoma, was without a doubt dismal to the patient, so earlier diagnosis would have been preferable. Conclusion: When a patient presents with an unusual history of hematoma in the extremities, it is necessary to consider the possibility of a malignant soft tissue tumor.