Ultrasound of Musculoskeletal Hematomas: Relationship of Sonographic Appearance to Age and Ease of Aspiration

• Published in: American journal of roentgenology (1976) Vol. 216; no. 1; pp. 125 - 130
• Main Authors: Yoon, Edward S, Lin, Bin, Miller, Theodore T
• Format: Journal Article
• Language: English
• Published: United States 01-01-2021
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Cohort Studies; Female; Hematoma - diagnostic imaging; Hematoma - surgery; Humans; Male; Middle Aged; Musculoskeletal Diseases - diagnostic imaging; Musculoskeletal Diseases - surgery; Paracentesis; Treatment Outcome; Ultrasonography, Interventional; Young Adult; musculoskeletal; hematoma; ultrasound; aspiration
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.19.22752

The purpose of this study was to evaluate the safety and efficacy of ultrasound-guided aspiration of musculoskeletal hematomas, evaluate the associations between the sonographic appearance of hematomas and their age with ease of aspiration, and determine if there is an optimal time frame for aspiration.
A retrospective search of our radiology database was conducted using the keywords "hematoma" and "aspiration" for procedures performed from January 1, 2008, through September 28, 2017, by three fellowship-trained musculoskeletal radiologists. Associations between the ease of aspiration and echotexture of the hematoma and between the ease of aspiration and age of the hematoma were assessed with a marginal ordinal logistic regression model to account for patient-level clusters. Pairwise comparisons of the ease of aspiration between the different echotextures were adjusted for multiple comparisons with the Tukey-Kramer method. This same method was also used to calculate the odds ratio (OR) for the age of the hematoma and ease of aspiration and decompression. Clinical follow-up was assessed for infection and symptomatic relief.
The cohort was composed of 148 patients (77 male and 71 female patients) with a mean age of 48 years (age range, 16-80 years). One hundred patients underwent clinical follow-up: There were no instances of infection and all patients reported symptomatic relief. Marginal proportional odds model showed an OR of 3.77 when comparing the ease of aspiration between hypoechoic hematomas and hematomas showing the other echotextures combined (i.e., complex, heterogeneous, echo-genic), which was statistically significant (
= 0.010). The OR of the ease of aspiration in relation to the age of a hematoma for each additional week was 1.03 with a
value of 0.547, which shows that there is no correlation between the age of the hematoma and ease of aspiration.
Ultrasound-guided aspiration of hematomas is a safe and effective procedure. The sonographic appearance of a hematoma is unrelated to its age. Although a hematoma with a hypoechoic appearance is easier to aspirate than hematomas with other echotextures, the appearance and age of a hematoma should not dissuade one from trying to aspirate it.