Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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A Rare Atypical Case of Asymptomatic and Spontaneous Intraneural Hematoma of Sural Nerve: A Case Report and Literature Review

  • Shin Hyuk Kang (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital) ;
  • Il Young Ahn (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital) ;
  • Han Koo Kim (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital) ;
  • Woo Ju Kim (Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital) ;
  • Soo Hyun Woo (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital) ;
  • Seung Hyun Kang (Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital) ;
  • Soon Auck Hong (Department of Pathology, Chung-Ang University Hospital) ;
  • Tae Hui Bae (Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital)
  • Received : 2023.06.29
  • Accepted : 2023.11.24
  • Published : 2024.03.15
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Abstract

Intraneural hematoma is a rare disease that results in an impaired nerve function because of bleeding around the peripheral nerve, with only 20 cases reported. Trauma, neoplasm, and bleeding disorders are known factors for intraneural hematoma. However, here we report atypical features of asymptomatic and spontaneous intraneural hematoma which are difficult to diagnose. A 60-year-old woman visited our clinic with the complaint of a palpable mass on the right calf. She reported no medical history or trauma to the right calf and laboratory findings showed normal coagulopathy. Ultrasonography was performed, which indicated hematoma near saphenous vein and sural nerve or neurogenic tumor. We performed surgical exploration and intraneural hematoma was confirmed on sural nerve. Meticulous paraneuriotomy and evacuation was performed without nerve injury. Histological examination revealed intraneural hematoma with a vascular wall. No neurologic symptoms were observed. In literature review, we acknowledge that understanding anatomy of nerve, using ultrasonography as a diagnostic tool and surgical decompression is key for intraneural hematoma. Our case report may help establish the implications of diagnosis and treatment. Also, we suggested surgical treatment is necessary even in cases that do not present symptoms because neurological symptoms and associated symptoms may occur later.

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References

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