Ultrasound-Guided Suction Technique for Trauma- Related Large Consolidated Buttock Hematoma A Case Report Chul-Ho Kim, MD, Yoonseok Kim, MD, and Jaeyoung Kim, MD Investigation performed at the Department of Orthopedic Surgery, Armed Forces Daejeon Hospital, Daejeon, Korea Abstract Case: Occasionally, a large, deep, consolidated hematoma is hard to evacuate without an incision, yet there are concerns about possible complications of surgical removal. We present a case of a 21-year-old military recruit with a large submuscular buttock hematoma that was successfully treated with an ultrasound-guided suction technique under local anesthesia using only a stab incision. Conclusions: The ultrasound-guided suction technique for a large hematoma was safe and effective in this patient. A deeply located hematoma from a direct trauma is not a rare condition. Usually, conservative management is accepted as the first choice of treatment based on rest, icing, compression, and elevation 1 . However, intervention is appropriate when the hematoma is complicated by uncon- trolled bleeding or a huge space-occupying lesion, which affects surrounding structures 2,3 . Minimally invasive tech- niques such as image-guided aspiration or pigtail catheter insertion are often preferred 4 , but in certain cases with a neurologic symptom or consolidated hematoma, it is difficult to apply those modalities. In those cases, hematoma evacua- tion is indicated 5,6 . Exploration of a hematoma with a long incision is the modality of choice for evacuating hematomas, but it leads to increased morbidity and prolonged hospital stay. For these reasons, conservative management is preferred for most hematomas, but it also causes a delay in recovery period and, in rare cases, an infection, especially in immu- nocompromised patients 7 . A gluteal, trauma-related hematoma is a common con- dition. In this case report, we describe an ultrasound-guided suction drainage technique following a stab incision and report a successful treatment result. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. Case Report A 21-year old military recruit came to the emergency room in our hospital with severe left buttock pain after direct injury by falling during a basketball game a day prior. He rested after the injury, but the pain increased. When he was reviewed in the emergency department, he had decreased sensation over the left buttock. An enhanced computed tomography imaging study was performed and revealed a space-occupying lesion as large as about 10 · 12 · 7 cm between the gluteus maximus muscle and the great trochanteric region on his left buttock. Considering imaging features and correlated to trauma history, we assessed it as a hematoma lesion. To set an initial treatment plan, ultrasonography (General Electric) was performed. Well-defined heteroge- neous echoic images suggest consolidation of the hematoma under the gluteus maximus muscle (Fig. 1). The patient was Fig. 1 Hematoma lesion was seen under tension in the patient’s left buttock. Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJSCC/A955). 1 COPYRIGHT Ó 2019 BY THE J OURNAL OF BONE AND J OINT SURGERY,I NCORPORATED JBJS Case Connect 2019;9:e0199 d http://dx.doi.org/10.2106/JBJS.CC.19.00199