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Magnetic resonance imaging can be effective in definitively diagnosing chronic seroma.
The accumulation of sterile serum within a confined area of tissue is termed a seroma.1 The development of a seroma is most frequently associated with surgical interventions that involve the development of large skin flaps during the procedure.1 This postoperative complication of soft-tissue dissection and muscle harvesting is commonly observed in patients who have undergone mastectomy, axillary and groin dissection, and sizeable anterior hernias.24 This article introduces the unique diagnosis of subperiosteal seroma in the leg of a football player following a direct contact injury without surgical intervention.
CASE REPORT
A 19-year-old collegiate football player reported leg pain after a direct contact injury that resulted from being struck on the anteromedial leg by another player's knee brace. After resting a few plays, he returned to full practice and sought no treatment afterwards.
The following day, he presented with numbness and tenderness to palpation over the leg. On gross examination, a hematoma was evident over the area in question. He initially was treated conservatively with ice, compression, and soft-tissue massage. Over the next two weeks, treatment progressed to moist heat, ultrasound, and therapeutic exercise aimed at restoring strength and flexibility of the ipsilateral knee and ankle. Once complete resolution of symptoms was achieved, a protective pad was fabricated for protection from re-injury and the patient was cleared to resume full athletic participation.
Approximately five months after the initial injury, he presented with swelling, pain associated with palpation and weight bearing, and severe erythema in the region of the initial injury following running a series of wind sprints. The athletic trainer, in collaboration with the team orthopedic surgeon, agreed on the need to differentially diagnose between an abscess, osteomyelitis, hematoma, tumor, and myositis ossificans. As the athlete was febrile at the time of exam, he was subsequently started on a course of antibiotics. Further, he began application of moist heat compresses to the area and was withheld from lower limb weight training and running activities.
Within three days of antibiotic therapy and moist heat compression, the athlete was afebrile although symptoms persisted. The palpable mass was noted to be somewhat firmer and subsequently was aspirated yielding a clear blood tinged serum. Results of the...