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IIiopsoas muscle hematoma

Case contributed by Mohammad A. ElBeialy
Diagnosis almost certain

Presentation

A haemophilic young man with right abdominal pain and swelling.

Patient Data

Age: 20 years
Gender: Male
ct

Large right iliopsoas muscle heterogeneous, predominantly fluid density, mass lesion with hyperdense content having their attenuation similar to blood (average density is 60 HU)  is seen measuring 20 X 10.5 X 10 cm in its maximal orthogonal dimensions. The lesion shows no post-contrast enhancement. Mild perilesional fat stranding is noted. The lesion is seen indenting the related superior portion of the right psoas muscle and splaying the related bowel loops as well as splaying the pelvic portion of the right ureter and mildly indenting the right aspect of the urinary bladder.

A few incidental tiny bilateral renal stones.

Case Discussion

Right iliopsoas non-enhancing hemorrhagic mass lesion; consistent with iliopsoas hematoma (haemophilic pseudotumor), in the clinical setting of bleeding diathesis with hemophilia.

The main differential diagnosis of iliopsoas hematoma (haemophilic pseudotumor) is:

  • Iliopsoas abscess: marginally enhancing lesion usually through local spread from a nearby infection, e.g. tuberculous spinal spondylodiscitis, perinephric abscess, appendicitis, diverticulitis, Crohn disease, or perforated colonic carcinoma that is secondarily infected. Primary iliopsoas abscesses are rare and mostly in immunocompromised patients.
  • Iliopsoas tumors: sarcoma is most likely with the presence of heterogenous enhancement, lymphadenopathy, bone destruction, and extension across the retroperitoneal facial planes favor the diagnosis of iliopsoas malignant mass. Iliopsoas metastases are rare; with the primary site possibly being breast, ovary, cervical carcinoma, lung, lymphoma, or malignant melanoma.  

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