HSS Ultrasound of the Month Case 102

Clinical History 26 year old professional football player with thigh tightness after injury

Ultrasound of the Month – Case 102

1

Ultrasound of the Month – Case 102

2

Ultrasound of the Month – Case 102

3

Ultrasound of the Month – Case 102

4

Diagnosis: Intramuscular Hematoma of the Vastus Intermedius A tear or strain of the muscle can result in an intramuscular hematoma, which can be a source of persistent pain and delayed healing.

Both MRI and ultrasound are excellent modalities for diagnosing intramuscular hematomas of the extremities such as in the thigh.

Ultrasound has the added benefit of being more cost-effective and more readily available compared to MRI. Additional benefit of ultrasound is the ability to guide percutaneous interventions, such as aspiration of the hematoma.

Fluid collections such as hematomas can have a variety of appearances on ultrasound based on the internal content and whether they are clotted. Simple fluid tends to be “anechoic” or black on ultrasound, while complex or clotted fluid tends to be “hyperechoic” or similar in brightness to muscle. Hyperechoic fluid, such as clotted blood, may not be drainable percutaneously and the radiologist often can predict how easily a collection would be drainable based on the ultrasound appearance of the collection.

Ultrasound of the Month – Case 102

5

Ultrasound of the Month – Case 102

6