case_images: PMC11176498_01
case_images: Examination of the patient. (A): Contrast- enhanced computed tomography revealed extravasation of the contrast in the hematoma (red arrow). (B): Emergency interventional radiology showed vascular leakage (red arrows). (C): B-mode ultrasound demonstrates thickening of the skin and subcutaneous fat layer on the back, characterized by uneven echogenicity, with a maximum thickness of 2.7 cm. CDFI reveals abundant blood flow signal within the affected area. Spectral Doppler analysis exhibits arterial- and venous-like flow patterns. An increase in the thickness of the deep fascia is evident, measuring up to 2.9 mm at its thickest point. (D): MRI scan reveals soft tissue thickening and enlarged vascular structures in lower back.
case_images: fonc-14-1387966-g001.jpg
case_images: PMC11176498_01_fonc-14-1387966-g001.jpg
case_images: f1
case_images: Enhanced CT scans showed subcutaneous hematoma in the right trunk, with local contrast agent accumulation in it, indicating the presence of active bleeding ( Figure 1A ). Figure 1B ), subsequent embolization was successfully executed to arrest the bleeding. Following the surgery, the patient's HB levels remained stable and showed a gradual increase over time. MRI (see  Figure 1D ) were admitted. Multiple cafe-au-lait macules were observed across various regions of the body, including the trunk, buttocks, and limbs.
case_images: A photographic series illustrating the patient's condition before and after our treatment. (A-C): A substantial subcutaneous hematoma on the right side of the trunk. The hematoma is noted for its remarkable size, measuring 33 cm in length, 16 cm in width, and 10 cm in depth, indicating a significant accumulation of blood beneath the skin. (D): The appearance of the inner wall tissue of the hematoma during the surgical procedure. It's dark red and fragile, with a tendency to bleed upon contact. (E): Pathological image. This is observed under a hematoxylin and eosin stain at an original magnification of 40 times. (F, G): Successful healing of skin grafts at one month post-procedure.
case_images: fonc-14-1387966-g002.jpg
case_images: PMC11176498_01_fonc-14-1387966-g002.jpg
case_images: f2
case_images: A hardened eschar, indicative of necrotic skin, measuring approximately 20 cm by 15 cm, was present on the mass, accompanied by mild erythema and edema in the adjacent tissue (refer to  Figures 2A-C ). The internal surface of the hematoma displayed a dark red coloration and was fragile, readily bleeding upon contact (see  Figure 2D ). Based on the pathological examination of the hematoma inner wall tissue, which showed the presence of diffuse cutaneous neurofibromas and thin-walled ectatic blood vessel (see  Figure 2E ), along with the results of the general physical examination (numerous cafe-au-lait macules), the patient met the diagnostic criteria for NF1. The skin grafts healed well (see  Figures 2F, G ).
case_images: Timeline of the case.
case_images: fonc-14-1387966-g003.jpg
case_images: PMC11176498_01_fonc-14-1387966-g003.jpg
case_images: f3
case_images: A timeline of the case was presented where all the important events were marked (see  Figure 3 ).