대한흉부영상의학회 Weekly Chest Cases

Case No : 407 Date 2005-08-15

Courtesy of Chin A Yi, MD. Tae Sung Kim MD. / Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Age/Sex 67 / F
Chief ComplaintRight pneumonectomy for pulmonary tuberculosis, 30 years ago Dyspnea on exertion for 3-4 months

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Diagnosis With Brief Discussion

Diagnosis: Chronic Expanding Hematoma in Chronic Tuberculous Empyema
Radiologic Findings: Serial chest plain radiographies with two-year interval disclosed that right pneumonectomy space is slowly expanding, shifting the mediastinum to the left side.

CT showed a large heterogeneous mass with some low attenuated areas in right pneumonectomy space and a wall containing flecks of calcifications. With enhancement, prominent vascular structures were enhanced in the periphery and small amount of contrast media was spreading out in the periphery.

Differential diagnosis could be chronic organizing hematoma. The possibility of malignant tumor, such as sarcoma or lymphoma, is very low. PET images showed large mass in right hemithorax with central photon defect area, supporting the benign nature of space occupying lesion in right pneumonectomy space.

At the opening of right hemithorax, the gush of black bloody material was found from the incision site. The pathologic diagnosis was a chronic organizing hematoma with no malignant cells.
Brief Review: Chronic expanding hematoma of the thorax is a rare entity. Affected patients typically have a history of medical or surgical therapy for tuberculosis. The presenting symptom is usually dyspnea related to lung compression or a slowly growing chest wall mass, both of which develop 30 years or more after treatment for tuberculosis.

The pathogenesis of chronic expanding hematomas is poorly understood. Labadie and Glover theorized that this self-perpetuating expanding process is due to the irritant effects of blood and its breakdown products, which cause repeated episodes of bleeding from capillaries in the granulation tissue.
References: 1. Hwang GL, Moffatt SD, Mitchell JD, et al. Chronic expanding hematoma of the thorax. AJR Am J Roentgenol. 2004; 183:243-244.

2. Roper CL, Cooper JD. Chronic expanding hematoma of the thorax. J Thorac Cardiovasc Surg 2001; 122:1046-1048.
Keywords: Pleura, Non-infectious inflammation, Bacterial infection,

No. of Applicants : 28

▶ Correct Answer : 1/28, 3.6%

- ASL Bologna, Maggiore Hospital, Bologna, Italy Marcellino Burzi

▶ Semi-Correct Answer : 15/28, 53.6%

- Gwangju Veterans Hospital, Korea Mee-Young Nam
- Yonsei University Hospital, Korea Eun Hye Yoo
- Monaldi Hospital, Naples, Italy Gaetano Rea
- Dong-Eui Medical Center, Busan, Korea Hoon Sik Jung
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Yangjoo Hospital, Korea Hae Jum Yang
- Yonsei University Hospital, Korea Hyun Suk Choi
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Radiologie Guiton, La Rochelle, France Denis Chabassiere
- Incheon Sarang Hospital, Incheon, Korea Jung Hee Kim
- Cabinet de Radiologie Guiton, La Rochelle, France Jean-Luc Bigot
- Max Hospital, New Delhi, India Vickrant Malhotra
- Ping Tung Christian Hospital,Taiwan Jun-Jun Yeh
- SSGH, Vadodara Medical College, Gujarat, India Sushil Mansingani

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 407 Date 2005-08-15

Discussion

No. of Applicants : 28