49 y/o with Renal Failure, Pain after Fall

49 year-old male with end stage renal failure (on hemodialysis), metabolic acidosis, hypothyroidism, anemia, chronic heparin-induced thrombocytopenia, and hypertension presented with pain after a fall while smoking.

Figure 1. A, AP radiograph of the femur and B, lateral radiograph of the femur show a large mass (thick arrow) with calcifications. Incidental note is made of bone infarct (long arrow) in the distal femur and bone island in the proximal tibia (small arrow).

Figure 2A. Coronal STIR-weighted image of the femur shows a heterogeneous mass predominant fluid signal intensity surrounded by a capsule.

Figure 2B. Coronal T1-weighted image of the femur shows a heterogeneous mass predominant fluid signal intensity surrounded by a capsule.

Figure 2C. Axial T1 FS image of the femur shows a heterogeneous mass predominant fluid signal intensity surrounded by a capsule.

Figure 2D. Axial PD FS image of the femur shows a heterogeneous mass predominant fluid signal intensity surrounded by a capsule.

Figure 2E. Sagittal T2 FS non-contrast image of the femur shows a heterogeneous mass predominant fluid signal intensity surrounded by a capsule.

Figure 3A, B. Axial of the femur show a heterogeneous mass (thick arrow) with calcifications. Incidental note is made of bone infarct (long arrow) in the distal femur.

Figure 3C, D. Coronal and sagittal non-contrast CT of the femur show a heterogeneous mass (thick arrow) with calcifications. Incidental note is made of bone infarct (long arrow) in the distal femur.

Diagnosis: Hematoma mimicking sarcoma

Radiographs in this case showed a large heterogeneous mass with calcifications without osteolysis or periostitis in the femur.

CT without IV contrast showed a large heterogeneous mass with calcifications.

MRI without IV contrast showed a heterogeneous mass with predominant fluid signal intensity surrounded by a capsule isointense to muscle on all sequences.

Edema and soft tissue thickening is sometimes associated with superficial leiomyosarcoma which was present in this case.

MRI may be useful in differentiating hematoma from sarcoma.

Sarcomas are rare malignant tumors arising from mesenchymal tissue that comprise muscle, fat, bone, blood vessels, and fibrous tissues.

Deep soft tissue leiomyosarcoma are larger than superficial soft tissue leiomyosarcoma, heterogeneous in enhancement due to internal hemorrhage and necrosis.

Hematoma may result from surgery, bleeding disorder, or trauma.

This patient presented with pain after trauma and had a large heterogeneous soft tissue mass that had calcifications and was diagnosed as sarcoma on initial biopsy but subsequent biopsy revealed it to be resolving hematoma.

This patient is a 49-year-old male with a large heterogeneous soft tissue mass with calcifications that measured approximately 12.0-17.2 cm that simulated sarcoma.

This case demonstrates that hematoma may be misdiagnosed as sarcoma.

Chronic expanding hematoma of the lower extremity can be difficult to differentiate from soft tissue sarcoma.

The differential diagnosis of cystic masses may include hematoma, hemangioma, lymphangioma, and synovial cyst.

This is a report of hematoma mimicking sarcoma describing the imaging features and management that may aid in prompt accurate diagnosis of hematoma and its differentiation from sarcoma.