Lee Y Y, Moser R, Bruner J M, Van Tassel P
AJR Am J Roentgenol. 1986 Jul;147(1):111-8. doi: 10.2214/ajr.147.1.111.
Five cases of pathologically proven organized intracerebral hematoma with recent hemorrhage are reported. The hemorrhages were spontaneous, were located in deep structures of the brain, and presented without a clinical history of hypertension or trauma. No underlying causes of the hematomas were identified histologically. Various computed tomographic (CT) patterns of recurrent hemorrhage in an organized hematoma were observed. A hyperdense, well demarcated mass with minimal contrast enhancement but no surrounding edema was observed when rehemorrhage was confined within a late-organizing hematoma. A "target" sign of a ring-enhancing mass was observed when the new hemorrhage developed within an early-organizing hematoma. When a new hemorrhage occurred outside a solid-enhancing organized hematoma, the CT appearance suggested a possible tumoral hemorrhage. Close clinical and CT follow-up is desirable for initial management of a suspicious rehemorrhaging organized hematoma situated in the deep-seated or superficial sensitive structures if the symptomatology has stabilized or improved. Tissue diagnosis and surgical evacuation are indicated when the clinical course fluctuates or progresses and CT demonstrates an interval increase of lesion.
报告了5例经病理证实的机化性脑内血肿伴近期出血的病例。出血为自发性，位于脑深部结构，且无高血压或外伤的临床病史。组织学检查未发现血肿的潜在病因。观察到机化性血肿复发性出血的各种计算机断层扫描（CT）表现。当再出血局限于晚期机化血肿内时，观察到一个高密度、边界清晰的肿块，对比增强 minimal 但无周围水肿。当新出血发生在早期机化血肿内时，观察到环形强化肿块的“靶”征。当新出血发生在实性强化的机化血肿外时，CT表现提示可能为肿瘤性出血。如果症状已稳定或改善，对于位于深部或浅表敏感结构的可疑再出血机化血肿的初始处理，密切的临床和CT随访是可取的。当临床病程波动或进展且CT显示病变间隔增大时，需进行组织诊断和手术清除。
