Intramuscular hematoma on the psoas muscle

Abstract

Intramuscular hematomas on the psoas muscle are rare and usually occur as a result of trauma, iatrogenic etiology during lumbar surgery, rupture of the aortic aneurysm, and hematologic diseases. The incidence of spontaneous psoas muscle hematomas has slowly increased as a result of using anticoagulation and antiplatelet agents. Magnetic resonance (MR) imaging is a more sensitive option compared to computed tomography (CT) when diagnosing a hematoma. Coronal T2-weighted images are more useful. CT imaging is also useful to establish the rapid diagnosis of hematoma. When a prolonged prothrombin time and international normalized ratio and decrease platelet count are noted, psoas muscle hematomas should be considered, if there was no lesion in the spinal canal. Most hematomas resolve spontaneously without clinical complications if the hematoma is not large or it is not compressing the surrounding important structures, irrespective of cause.

<p>Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report</p>

“…The risk of development of iliopsoas hematoma after anticoagulation therapy has been discussed by multiple authors. 1,28,29 Sarwat et al reported a case of a 31-year-old female with intractable lower back pain, who underwent a dynamic stabilization procedure from L3 to L5. Post-operatively she received prophylactic anticoagulants.…”

“…Most of iliopsoas hematomas are managed conservatively if there was no clinical and hemodynamic deterioration. 1,31 This can include stopping anticoagulants, fluid and blood administration and close observation with monitoring of hemoglobin and coagulation profile. 32 However, surgical intervention is recommended by others in case of hemodynamic instability despite resuscitation and neurological deficit.…”

“…Intramuscular psoas Hematoma is an uncommon condition and it has multiple causes including trauma, use of anticoagulation, iatrogenic injury during lumber procedure and bleeding disorders. 1 Extreme Lateral Interbody Fusion (XLIF) is a far lateral approach; allowing access to the anterior aspect of the spine from the level of T6 to the level of L5. 2 This minimally invasive surgery is retroperitoneal using a muscle splitting approach through the psoas muscle.…”

Non-penetrating traumatic psoas muscle hematoma presenting with gross hematuria: a case report

“…Psoas muscle hematoma is defined as a spontaneous or traumatic retroperitoneal collection of blood involving the psoas muscle [ 2 ]. Hematomas on the psoas muscle occur secondary to trauma, leaking abdominal aortic aneurysms, iatrogenic etiology during lumbar surgery including endoscopic discectomy, recent biopsy, tumor, use of anticoagulants, or coagulation disorders such as disseminated intravascular coagulation and hemophilia [ 3 , 4 ]. As a general rule, coagulopathies and trauma are etiologic factors in the younger population while anticoagulant therapy and aortic aneurysm rupture assume prominence in the older age range [ 4 ].…”

“…Whether incidental diagnosis is frequent, clinical presentation depends on the severity of the hemorrhage, varying from compressive symptoms, such as groin or thigh pain, muscle dysfunction, numbness or paresthesia of the unilateral lower extremity, and occasionally nerve palsy with the femoral nerve involvement and anemia [ 1 , 2 ]. Ecchymosis in the periumbilical area (Cullen’s sign) or in the flanks (Grey-Turner's sign) may occur [ 3 ].…”