What is the management approach for a seroma or hematoma identified on ultrasound?

Management of Seroma or Hematoma Identified on Ultrasound

For seromas or hematomas identified on ultrasound, management should be based on the patient's clinical presentation, with ultrasound-guided aspiration as the primary intervention for symptomatic collections, while asymptomatic collections can often be monitored without intervention. 1

Initial Assessment and Diagnostic Approach

• Ultrasound is the initial imaging procedure of choice for evaluating seromas or hematomas, especially for extracavitary collections, as it can be performed at bedside, is inexpensive, and allows for aspiration for analysis and culture if needed 1
• Ultrasound can effectively detect fluid collections and pseudoaneurysms, though it cannot always differentiate between seroma, hematoma, or abscess 1
• For indeterminate findings on ultrasound, consider CT or MRI, which offer better characterization of fluid collections and surrounding tissues 1

Management Algorithm

For Asymptomatic Collections:

• If the patient is asymptomatic, therapeutic interventions are generally not recommended to avoid unnecessary procedural risks 1
• Implement regular monitoring with follow-up ultrasound examinations to assess for changes in size or characteristics 1
• Patients with asymptomatic collections should be monitored for signs of infection, including fever, increasing pain, or erythema over the collection site 1

For Symptomatic Collections:

1. Ultrasound-guided aspiration is the primary intervention for symptomatic seromas or hematomas 1, 2

   • Aspiration reduces the risk of infection and improves patient comfort 2
   • Ultrasound guidance significantly reduces procedural complications compared to blind aspiration 1

2. Post-aspiration management:

   • Apply pressure dressing after aspiration to prevent reaccumulation 3
   • For recurrent seromas, serial aspirations may be necessary 4
   • Consider pressure garments for persistent collections, especially in accessible areas 4

3. For persistent or recurrent collections:

   • Implement more frequent ultrasound monitoring 1
   • Consider sclerosing agents for persistent seromas that recur after multiple aspirations 4
   • Surgical intervention may be necessary for collections that fail to resolve with repeated aspirations 5

Special Considerations

For Vascular Graft-Related Collections:

• Carefully monitor for complications of vascular graft seromas based on individual circumstances 1
• For arteriovenous graft seromas, management should be based on the patient's clinical presentation, local expertise, and resources 1
• Ultrasound can identify subcutaneous or perigraft fluid collections that could be aspirated for analysis and culture 1

For Post-Surgical Collections:

• Risk factors for developing seromas include higher body mass index, larger tissue dissection, use of synthetic mesh, and smoking 2, 4
• Seromas occurring after breast surgery or implant placement require careful monitoring due to increased risk of infection and potential implant loss 3
• For collections near prosthetic materials, more aggressive management may be warranted to prevent infection 1

Complications and Follow-up

• Monitor for signs of infection following aspiration, as this is the most common complication 2
• Patients with cirrhosis or coagulopathy undergoing aspiration should be monitored for bleeding complications 1
• Follow-up ultrasound after aspiration can confirm adequate drainage and monitor for recurrence 1
• For collections that persist despite multiple aspirations, consider referral to a specialist for potential surgical management 5, 4

Pitfalls to Avoid

• Avoid multiple blind aspirations without imaging guidance, as this increases risk of complications 1
• Do not manipulate collections near vascular structures without proper imaging guidance to avoid vascular injury 1
• Recognize that seromas near implants or prosthetic materials carry higher risk of infection and may require more aggressive management 3
• Avoid delaying intervention for symptomatic collections as this may lead to increased risk of infection and patient discomfort 2, 4