Can An MRI Scan Detect Hematomas?

Posted on Wed, 9 Aug 2017

Question: I have asked a few times on here already about a hematoma my daughter developed by her spine/next to spine in January. We had MRI with contrast done, xray and ultrasound and the radiologist said its a hematoma, doctor agreed, we also had a surgeon look for a 2nd opinion. Today it is 75% smaller but not entirely gone yet. We had follow up appts and the doctor said more time, he's not worried about it. Can these take a year to go away? It's still hard, not as hard...it just bothers me that it's still there. Are MRIs accurate in diagnosing hematomas?

Answered by Dr. T Chandrakant (37 minutes later)

Brief Answer:
MRI is usually accurate

Detailed Answer:
Hi.
Thanks for your query.
Read the history about your daughter and understood your concerns.
Please give additional information for me to assist you better:
Was there any injury that caused hematoma?
Are there any symptoms related to the lump?
What is the size now? Is it XXXXXXX or fixed?
Is the skin above normal?
What is the age of patient?
When was MRI done?
Please post the report of MRI and clear, focused photos if possible.

MRI diagnosis of hematoma can be accurate.
Also needed is proper history, clinical evaluation, aspiration if done to confirm the diagnosis.
It does not take so long in resolution of a hematoma.
Persistence of a lump after 6-7 months indicate a sequel of organization of hematoma with fibrosis or calcification if hematoma was well diagnosed.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (8 minutes later)

They figured she either did something while doing headstands all weekend or fell just right on her back. No symptoms related to lump. The size now is about 3/8 inch, was the size of a quarter at least when we first found it, MRI measured it at 1.9cm. Stuck out like a golf ball, no longer sticks out like that. It moves just a little but not much, they said it's intramuscular. Not attached to skin, skin is normal colored. My daughter is 11, MRI was done in February. I don't have the MRI report other than what they told me, that they strongly suspect hematoma. No differential diagnosis. If something gets smaller, it's not likely something serious like cancer correct? I mentioned to them sarcoma and they said nothing on the MRI showed anything like sarcoma. I have anxiety and this thing just bothers me. They said because of where it is it could take a while to dissolve.

Also the surgeon said he would watch it because it has shrunk, but will remove it if we want it to be removed. Is there any chance it could still go away?

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
Review - HRUSG - FNAC

Detailed Answer:
Hi.
Thanks for your feedback.
Anything that is present for 6 months and reducing in size can not be cancerous. And MRI would have shows something.
I would advise you to get a review by your Surgeon, request for High Resolution Ultrasound (HRUSG) and FNAC (fine needle aspiration cytology) to get a confirmed diagnosis and a plan of further management if need be.
Very difficult to say that it would go away.

I hope this answers your query.
Please feel free to ask for further relevant queries if you feel that there is a gap of communication.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (9 minutes later)

Why the need for further work up when she has had a full work up already? She had a detailed ultrasound that showed no blood flow to the lump. I guess I just want another opinion other then her doctors she has been seeing. None of them seem worried about it at all and said it should go away. In fact the surgeon said he doesn't need to see her again unless I keep worrying about it and want it removed. Her doctor pretty much said the same thing after her last check on it. It has shrunk enough that they aren't concerned. Her doctor said they were worried about it calcifying but he wasn't worried about that anymore. I guess it's reassuring that if it was cancer it would have grown and not shrunk during these 6 months.

Answered by Dr. T Chandrakant (15 minutes later)

Brief Answer:
Yes, wait and watch policy.

Detailed Answer:
Certainly yes.
When was the last ultrasound done?
If it is shrinking, no symptoms, ultrasound did not show a blood flow to the lump, no worry then.
In my opinion you can follow the policy of wait and watch.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (4 minutes later)

Last ultrasound was done in February immediately after they did the MRI. I'm guessing they did that to see if she had an active bleeding vein?

That is just a guess though, they didn't really tell us why they wanted an ultrasound after the mri. As far as I know, an MRI gives a better pic then an ultrasound? All I know is that it showed no blood flow to the lump, that's all they told us.

Answered by Dr. T Chandrakant (1 hour later)

Brief Answer:
USG and MRI has its own advantages.

Detailed Answer:
Feb is a long ago.
It is better to have a review; helps to know the exact condition at the moment and helps to alleviate the anxiety.
Ultrasonography is done in real time and has color doppler attachment that can show the blood flow, also help for guided FNAC if needed. Also has good picture quality, albeit MRI has its own advantages for the better picture quality.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (7 minutes later)

So are you saying we can still watch and wait? I'm so confused. How can the lump change from a hematoma to something else?

Answered by Dr. T Chandrakant (12 minutes later)

Brief Answer:
This is called sequel

Detailed Answer:
Change of hematoma to something else is called a sequel as I have mentioned above and is a normal natural process in some patients.
I advised to have an Opinion of the Surgeon, an ultrasound with color doppler and FNAC if required to know the exact position and thus know the prognosis since the last Ultrasound and MRI were done a long ago and the lump still remains although has reduced in size.
This will also help to reduce the stress/anxiety.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (9 minutes later)

So are you saying the shrinking lump could be something more serious then a hematoma? Again the surgeon doesn't want to see us back, this was in May unless we decided to have it removed. He said in his words, if this was my child I would watch and wait. I don't know what to do!

Answered by Dr. T Chandrakant (11 minutes later)

Brief Answer:
There are tow options to choose from.

Detailed Answer:
If your Surgeon has so well assured you, why is so much anxiety?
We have two options: one is to wait and watch and another as mentioned above.
If you are still not assured go for second option and alleviate the stress.
There is nothing to be confused.
If the confusion prevails then too go for second option to get the recent status.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. T Chandrakant (1 minute later)

Thank you for your help!!

Answered by Dr. T Chandrakant (10 minutes later)

Brief Answer:
Thanks for your appreciation

Detailed Answer:
You are most welcome.

Note: For further inquiries on surgery procedure and its risks or complications book an appointment now

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar