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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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A rectus sheath hematoma is an accumulation of blood in the sheath of the rectus abdominis muscle. It causes abdominal pain with or without a mass.
The hematoma may be caused by either rupture of the epigastric artery or by a muscular tear. Causes of this include anticoagulation, coughing, pregnancy, abdominal surgery and trauma. With an ageing population and the widespread use of anticoagulant medications, there is evidence that this historically benign condition is becoming more common and more serious.
On abdominal examination, people may have a positive Carnett's sign.
Most hematomas resolve without treatment, but they may take several months to resolve.
Factors increasing the risk of a subdural hematoma include very young or very old age. As the brain shrinks with age, the subdural space enlarges and the veins that traverse the space must travel over a wider distance, making them more vulnerable to tears. This and the fact that the elderly have more brittle veins make chronic subdural bleeds more common in older patients. Infants, too, have larger subdural spaces and are more predisposed to subdural bleeds than are young adults. For this reason, subdural hematoma is a common finding in shaken baby syndrome. In juveniles, an arachnoid cyst is a risk factor for a subdural hematoma.
Other risk factors for subdural bleeds include taking blood thinners (anticoagulants), long-term alcohol abuse, dementia, and the presence of a cerebrospinal fluid leak.
The anatomy of the epidural space is such that spinal epidural hematoma has a different presentation from intracranial epidural hematoma. In the spine, the epidural space contains loose fatty tissue and a network of large, thin-walled veins, referred to as the epidural venous plexus. The source of bleeding in spinal epidural hematoma is likely to be this venous plexus.
If diagnosed within the first few hours of presentation, the pooling blood may be evacuated using a syringe. Once the blood has clotted, removal by this method is no longer possible and the clot can be removed via an incision over the lump under local anesthetic. The incision is not stitched, but will heal very well. Care needs to be taken in regard to bleeding from the wound and possible infection with fecal bacteria. If left alone it will usually heal within a few days or weeks. The topical application of a cream containing a Heparinoid is often advised to clear the clot .
A breast hematoma may appear due to direct trauma to the breast, for example from a sports injury or a road accident, for example a vehicle collision in which a seat belt injury occurs.
Hematoma can also be a consequence of breast surgery, usually due to post-operative bleeding. Bleeding may occur shortly after the intervention or a number of days later and can occur for cosmetic surgery (for example breast reduction or breast enhancement) and for non-cosmetic surgery (for example lymph node removal, lumpectomy, or mastectomy). More rarely, hematoma can result from breast biopsy.
Rarely, a breast hematoma can also occur spontaneously due to a rupture of blood vessels in the breast, especially in persons with coagulopathy or after long-term use of blood-thinning drugs such as aspirin or ibuprofen.
Small breast hematomas often resolve on their own within several days or weeks by means of reabsorption of the blood. Larger hematomas are more likely to lead to inflammation or fibrosis.
Breast hematomas can sometimes lead to skin discoloration, inflammation, or fever. When a hematoma resolves, it may become fibrotic, leaving behind scar tissue. A resolving hematoma may liquify to form a seroma.
Post-surgical breast hematomas can also impede wound healing and therefore impact the cosmetic outcome. Hematomas are furthermore one of the risk factors for breast surgical site infections. There is preliminary evidence that, after breast implant surgery, the presence of hematoma increases the risk of developing capsular contracture.
In mammography screening, scar tissue resulting from a breast hematoma can easily be confused with tumor tissue, especially in the first years following surgery. Ultimately, fat necrosis may occur in the concerned region of the breast.
Arachnoid cysts are seen in up to 1.1% of the population with a gender distribution of 2:1 male:female Only 20% of these have symptoms, usually from secondary hydrocephalus.
A study that looked at 2,536 healthy young males found a prevalence of 1.7% (95% CI 1.2 to 2.3%). Only a small percentage of the detected abnormalities require urgent medical attention.
Perianal hematoma are caused by the rupture of a small vein that drains blood from the anus. This rupture may be the result of forceful or strained bowel movement or caused by heavy lifting, coughing or straining. Once the rupture has formed, blood quickly pools within a few hours and, if left untreated, forms a clot.
Subdural hematomas are most often caused by head injury, when rapidly changing velocities within the skull may stretch and tear small bridging veins. Subdural hematomas due to head injury are described as traumatic. Much more common than epidural hemorrhages, subdural hemorrhages generally result from shearing injuries due to various rotational or linear forces. Subdural hemorrhage is a classic finding in shaken baby syndrome, in which similar shearing forces classically cause intra- and pre-retinal hemorrhages. Subdural hematoma is also commonly seen in the elderly and in alcoholics, who have evidence of cerebral atrophy. Cerebral atrophy increases the length the bridging veins have to traverse between the two meningeal layers, hence increasing the likelihood of shearing forces causing a tear. It is also more common in patients on anticoagulants or antiplatelet drugs, such as warfarin and aspirin. Patients on these medications can have a subdural hematoma after a relatively minor traumatic event.
A further cause can be a reduction in cerebral spinal fluid pressure which can create a low pressure in the subarachnoid space, pulling the arachnoid away from the dura mater and leading to a rupture of the blood vessels.
The exact cause of arachnoid cysts is not known. Researchers believe that most cases of arachnoid cysts are developmental malformations that arise from the unexplained splitting or tearing of the arachnoid membrane.
In some cases, arachnoid cysts occurring in the middle fossa are accompanied by underdevelopment (hypoplasia) or compression of the temporal lobe. The exact role that temporal lobe abnormalities play in the development of middle fossa arachnoid cysts is unknown.
There are some cases where hereditary disorders have been connected with arachnoid cysts.
Some complications of arachnoid cysts can occur when a cyst is damaged because of minor head trauma. Trauma can cause the fluid within a cyst to leak into other areas (e.g., subarachnoid space). Blood vessels on the surface of a cyst may tear and bleed into the cyst (intracystic hemorrhage), increasing its size. If a blood vessel bleeds on the outside of a cyst, a collection of blood (hematoma) may result. In the cases of intracystic hemorrhage and hematoma, the individual may have symptoms of increased pressure within the cranium and signs of compression of nearby nerve (neural) tissue.
Some scientists debate whether arachnoid cysts are a true congenite condition or if this should be separated from secondary cysts. A recent study shows differences in communication between the arachnoid cyst and the subarachnoid space by CT cisternography
. A comparison of arachnoid cyst fluid and CSF in a series of patients show differences in chemical composition.
Arachnoid cysts can also occur secondary to other disorders such as Marfan syndrome, arachnoiditis, or agenesis of the corpus callosum.
Spinal epidural hematoma is bleeding into the epidural space in the spine. These may arise spontaneously (e.g. during childbirth), or as a rare complication of epiduralanaesthesia or of surgery (such as laminectomy). Symptoms usually include back pain which radiates to the arms or the legs. They may cause pressure on the spinal cord or cauda equina, which may present as pain, muscle weakness, or dysfunction of the bladder and bowel.
The best way to confirm the diagnosis is MRI. Risk factors include anatomical abnormalities and bleeding disorders.
Treatment is generally with emergency surgery. The risk following epidural anaesthesia is difficult to quantify; estimates vary from 1 per 10,000 to 1 per 100,000 epidural anaesthetics.
Prognosis for this condition varies according to extent of the hematoma, but is normally fairly good. Smaller hematomae carry a 99% chance of full recovery, with larger ones carrying a recovery rate ranging from 80 to 90%. Occasional epistaxis may follow the surgery, but this is temporary and should subside within 2 to 3 weeks after surgery.
Blunt splenic trauma occurs when a significant impact to the spleen from some outside source (i.e. automobile accident) damages or ruptures the spleen. Treatment varies depending on severity, but often consists of embolism or splenectomy.
A hematoma (US spelling) or haematoma (UK spelling) is a localized collection of blood outside the blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. A hematoma is initially in liquid form spread among the tissues including in sacs between tissues where it may coagulate and solidify before blood is reabsorbed into blood vessels. An ecchymosis is a hematoma of the skin larger than 10mm.
They may occur among/within many areas such as skin and other organs, connective tissues, bone, joints and muscle.
A collection of blood (or even a hemorrhage) may be aggravated by anticoagulant medication (blood thinner). Blood seepage and collection of blood may occur if heparin is given via an intramuscular route; to avoid this, heparin must be given intravenously or subcutaneously.
It is not to be confused with hemangioma, which is an abnormal buildup/growth of blood vessels in the skin or internal organs.
Blunt splenic trauma most often occurs in automobile accident victims, in which it is a leading cause of internal bleeding. However, any type of major impact directed to the spleen may cause splenic trauma. This can happen in bicycling accidents, when the handlebar is forced into the left subcostal margin, and into the spleen. The degree of injury ranges from subcapsular hematoma, to splenic rupture.
Some hematomas are visible under the surface of the skin (commonly called bruises) or possibly felt as masses/lumps. Lumps may be caused by the limitation of the blood to a sac, subcutaneous or intramuscular tissue space isolated by fascial planes. This is a key anatomical feature that helps prevent injuries from causing massive blood loss. In most cases the hematoma such as a sac of blood eventually dissolves; however, in some cases they may continue to grow such as due to blood seepage or show no change. If the sac of blood does not disappear, then it may need to be surgically cleaned out/repaired.
The slow process of reabsorption of hematomas can allow the broken down blood cells and hemoglobin pigment to move in the connective tissue. For example, a patient who injures the base of his thumb might cause a hematoma, which will slowly move all through the finger within a week. Gravity is the main determinant of this process.
Hematomas on articulations can reduce mobility of a member and present roughly the same symptoms as a fracture.
In most cases, movement and exercise of the affected muscle is the best way to introduce the collection back into the blood stream.
A mis-diagnosis of a hematoma in the vertebra can sometimes occur; this is correctly called a hemangioma (buildup of cells) or a benign tumor.
Complications such as rupture or other life-threatening conditions are rare. Treatment may involve surgery, particularly when signs indicating worsening are present (the patient is unable to control their pain or changes in blood pressure).
Intracranial hemorrhage is a serious medical emergency because the buildup of blood within the skull can lead to increases in intracranial pressure, which can crush delicate brain tissue or limit its blood supply. Severe increases in intracranial pressure (ICP) can cause brain herniation, in which parts of the brain are squeezed past structures in the skull.
Intracranial bleeding occurs when a blood vessel within the skull is ruptured or leaks. It can result from physical trauma (as occurs in head injury) or nontraumatic causes (as occurs in hemorrhagic stroke) such as a ruptured aneurysm. Anticoagulant therapy, as well as disorders with blood clotting can heighten the risk that an intracranial hemorrhage will occur.
Nasal septal hematoma is a condition affecting the nasal septum. It can be associated with trauma.
Because the septal cartilage has no blood supply of its own and receives all of its nutrients and oxygen from the perichondrium, an untreated septal hematoma may lead to destruction of the septum. Immediate drainage is necessary. Failure to recognise septal hematomas, or treat in a timely fashion, can cause a saddle nose deformity.
To treat a septal haematoma it is incised & drained to prevent avascular necrosis of the septal hyaline cartilage which depends on diffusion of nutrients from its attached nasal mucosa. Small hematomas can be aspirated with a wide-bore needle. Large hematomas are drained by an incision parallel to nasal floor. Systemic antibiotics are given after the incision and drainage to prevent local infection.
Treatment for a nasal septal abscess is similar to that of other bacterial infections. Aggressive broad spectrum antibiotics may be used after the infected area has been drained of fluids.
A penetrating atherosclerotic ulcer (PAU) is an atherosclerotic lesion that ulcerates, leading to a hematoma forming within the walls of the aorta.
The presence of subchorionic bleeding around the gestational sac does not have a significant association with miscarriage overall. However, the case of intrauterine hematoma observed before 9 weeks of gestational age has been associated with an increased risk of miscarriage. In one study women who complied with instructions for bed rest for the duration of bleeding had a lower rate of miscarriage and a higher rate of term pregnancy than non-compliant women. The study had several limitations; results were severely confounded by inherent differences between compliant and non-compliant women.
Ethmoid hematoma is a progressive and locally destructive disease of horses. It is indicated by a mass in the paranasal sinuses that resembles a tumor, but is not neoplastic by any means. The origins and causes of the ethmoid hematoma are generally unknown. Large hematomas usually start within the ethmoid labyrinth, and smaller ones tend to begin on the sinus floor.
The hematoma usually extends into the nasal passage. A growing hematoma causes pressure necrosis of the bone surrounding the hematoma, but only on rare occasions does it cause facial distortion. It is most commonly seen in horses older than six years. Mild, persistent, spontaneous, intermittent, and unilateral epistaxis is the most common sign clinically.