SONOWORLD : Right psoas muscle hematoma

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Musculoskeletal » Abdomen

Right psoas muscle hematoma

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Author(s) :

Chaitali Shah, FRCR

Presentation A young man on anticoagulation therapy presented with hematuria. An abdominal ultrasound was performed.

Caption: Transverse view of the mid-abdomen

Description: A mass of mixed echogenicity, as marked by the cursors, is seen in the right para-caval region. It displaces the right kidney medially and anteriorly.

Caption: Parasagittal image

Description: The hematoma complex seen in the right paracaval region is noted extending further along the course of the psoas muscle. An oblique section of the right kidney is visualized in this image.

Caption: Transverse labelled view of the mid-abdomen

Description: In a more superior transverse section, the retroperitoneal mass, liver and the kidney are seen. These are labelled as M, L and K respectively.

Differential Diagnosis Psoas hematoma, psoas abscess, tumor

Final Diagnosis Right psoas hematoma complex that developed as a side-effect of anticoagulation therapy

Discussion This case demonstrates a retroperitoneal hematoma, one of the side effects that may occur in patients on anticoagulation therapy. Ultrasound aids in the identification of the retroperitoneal hematoma and also allows for monitoring and follow up as the lesion resolves.

Case References 1. Rosset P, Mir A, Wassmer FA. Anticoagulants and psoas hematoma. Helv Chir Acta. 1991 Jul; 58(1-2):167-8.
2. Pretorius, E. Scott; Fishman, Elliot K.; Zinreich, S. James. Pictorial Essay. CT of Hemorrhagic Complications of Anticoagulant Therapy. Journal of Computer Assisted Tomography. 21(1):44-51, January/February 1997.

Follow Up This patient underwent a CT scan, which confirmed the ultrasound findings. Follow up ultrasound scans showed a gradual decrease in size of the hematoma.