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Conservative treatment - rest, ice, compression, elevation
10%
250/2467
Repeat core needle biopsy
6%
143/2467
Consult interventional radiography to place a drain under image guidance
3%
83/2467
Irrigation and debridement with initiation of postoperative antibiotics
62/2467
Open surgical biopsy
78%
1917/2467
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The history is concerning for a soft tissue sarcoma. Many sarcomas can bleed into the surrounding tissues or pseudocapsule making diagnosis difficult. Without a history of injury, trauma, or bleeding diathesis, the diagnosis of a hematoma must be entertained only after ruling out malignant causes for the symptoms. Given this patient's presentation with a slow growing mass, a negative core needle biopsy does not exclude a sarcoma. As such, open surgical biopsy is the treatment of choice. In a retrospective review, Ward et al showed a 7 month average delay in the 33 patients where a soft tissue sarcoma was misdiagnosed as a hematoma. These authors argue that the presence of sub-cutaneous ecchymosis is a finding which may help treating physicians make the difference between hematomas and soft tissue sarcomas, however, this point has not been supported in the literature.
2.8
(38)
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