Circumscribed intrapulmonary hematoma presenting as a coin lesion.

In recent years the problem of solitary circumscribed pulmonary nodules has attracted much attention in the medical literature. The difficulties involved in establishing an accurate diagnosis in cases of this kind are well recognized and are usually resolved by resort to exploratory thoracotomy and excision of the lesion. That this approach to the problem is rational and well founded is amply substantiated by the many excellent reviews on the subject which have established an incidence of malignancy in such cases varying from approximately 7 to 74 per cent and averaging about 37 per cent.1-il The major portion of this group is, of course, comprised by primary bronchogenic carcinoma, while metastatic tumors and other primary malignant diseases such as bronchial adenoma, sarcoma or lymphoblastoma make up a much smaller component. Non-malignant lesions which most commonly present as isolated pulmonary nodules are tuberculomas, granulomas of nonspecific origin, hamartomas, histoplasmomas and coccidioidomas. In addition to the above disorders there is a great variety of less common and even rare conditions which may assume the form of “coin” lesions and with which the physician must be familiar if he is even to consider the correct diagnosis prior to surgical exploration of the chest. To but mention some of these diseases-chronic organized pneumonit s, lung abscess, bronchogenic cyst, pleural mesothehioma, hipoid granuloma, neurofibroma, pulmonary infarct, encapsulated pleural effusion or empyema, blastomycosis, cryptococcosis, hemangioma, hydatid cyst, fibrin body and brucelhosis may all appear as solitary circumscribed pulmonary nodules. The following report purports to add to this list another condition which hitherto has received but little attention, that is, intrapulmonary hematoma. Persistent, circumscribed, intrapulmonary hematomas must be either extremely rare in occurrence or generally unrecognized if one can judge from the few cases which have appeared in the literature. Although a number of authors1”3 have briefly described or referred to hematoma formation in the lung, the roentgenographic changes produced by these lesions have been variously indicated as “spindle shaped”10’ ‘ or “ill defined”12 and have not presented the sharply circumscribed, round or oval appearance of the so-called “coin” lesion. Only the three cases reported by Salyer, Blake and Forse&4 and the single