Giant abdominal wall chronic expanding hematoma mimicking malignancy: A rare case of cosmetic concern in a middle-aged woman - case report and literature review.

INTRODUCTION AND IMPORTANCE

Hematomas typically resolve spontaneously; however, in rare cases, they may progressively enlarge, becoming encapsulated and fibrotic, forming a chronic expanding hematoma (CEH). CEH is a slowly enlarging lesion that may mimic malignancy on imaging, leading to diagnostic uncertainty. This report presents a rare case of a giant CEH of the anterior abdominal wall in a middle-aged woman following blunt abdominal trauma. The case emphasizes the importance of including CEH in the differential diagnosis of large soft-tissue masses and highlights the effectiveness of surgical excision in achieving definitive management.

CASE PRESENTATION

A 39-year-old healthy Palestinian female presented with a gradually enlarging, asymptomatic swelling in the lower abdomen, which developed following blunt abdominal trauma two years prior. A contrast-enhanced CT scan revealed a well-defined cystic lesion in the subcutaneous layer of the lower anterior abdominal wall, below the umbilical level. The patient underwent elective surgery, and histopathological analysis of the excised mass confirmed a benign cyst wall with dense fibrosis, chronic inflammation, and foci of hemorrhage.

CLINICAL DISCUSSION

CEH has been reported in various anatomical sites, such as the extremities and thoracic cavity, but remains rare in the abdominal wall. Differentiating it from malignant masses can be challenging; however, it should be considered in the differential diagnosis, especially in patients with a history of trauma and no systemic symptoms. Diagnosis relies on imaging findings and is confirmed histologically.

CONCLUSION

CEH should be considered in the differential diagnosis of slowly enlarging, cystic abdominal wall masses, particularly in patients with a history of trauma. Accurate diagnosis and timely surgical excision are essential to avoid unnecessary oncologic interventions.