title: Organized Hematoma: An Analysis of 84 Cases with Emphasis on Difficult Prediction and Favorable Management.
abstract: OBJECTIVE
  To characterize features of organized hematoma (OH) that may cause considerable diagnostic difficulties.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  Eighty-four patients with pathologically confirmed OH over a 10-year period were retrospectively reviewed for clinical features, imaging findings, pathologic characteristics, and treatment modalities.
  
  
  RESULTS
  This study included 39 males and 45 females who presented with frequent epistaxis and nasal obstruction. There were 62 (74%) patients >40 years old (mean, 50; range, 9-81). OH mainly originated in the maxillary sinus (n = 82) or nasal cavity (n = 2) unilaterally, and most were expansile masses (n = 73) that extended into nasal cavity (n = 71) or choanae (n = 17). Several lesions were locally aggressive and simulated a malignant process that involved the ethmoid sinus (n = 22), orbit (n = 11), pterygopalatine fossa (n = 16), infratemporal fossa (n = 9), cheek (n = 3), and hard palate (n = 3). Internal architecture on computed tomography (CT) scans showed OH with expansile remodeling of the maxillary wall (82.1%) and smooth bony destruction (70.2%), whereas T2-weighted magnetic resonance (MR) images showed inhomogeneity with a notable hypointense peripheral rim in all lesions. CT and MR contrast-enhanced images revealed patchy heterogeneous enhancement that could be interpreted according to histopathologic findings of hemorrhage and neovascularization. OH was successfully removed with endoscopic surgery, although 5 cases recurred.
  
  
  CONCLUSIONS
  OH can be successfully treated by endoscopic surgery. CT and MR examination provide characteristic findings for prediction and careful surgical planning.
authors: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Wenhui
authors: W
authors: Pang
authors: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Li
authors: L
authors: Hu
authors: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Huan
authors: H
authors: Wang
authors: Department of Radiology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Yan
authors: Y
authors: Sha
authors: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Na
authors: N
authors: Ma
authors: Department of Pathology, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Shuyi
authors: S
authors: Wang
authors: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Quan
authors: Q
authors: Liu
authors: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China.
authors: Xicai
authors: X
authors: Sun
authors: Department of Otolaryngology-Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, China wangdehuient@sina.com.
authors: Dehui
authors: D
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D003287:Contrast Media; D003952:Diagnostic Imaging; D004724:Endoscopy / Q000379:methods*; D004844:Epistaxis / Q000209:etiology / Q000601:surgery; D005260:Female; D019786:Gadolinium DTPA; D006406:Hematoma / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000209:etiology / Q000601:surgery; D010254:Paranasal Sinus Diseases / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA
keywords: computed tomography; endoscopic sinus surgery; magnetic resonance; organized hematoma; pathology