Psoas haematoma

Dr Yuranga Weerakkody and Dr Henry Knipe et al.

Psoas haematomas are located in the retrofascial space, rather than in the retroperitoneal space, because the psoas muscles are located in the iliopsoas compartment posterior to the transversalis fascia, which is the posterior boundary of the retroperitoneum.

Presentation is often vague and non-specific and may include abdominal, pelvic, back or groin pain and/or swelling. There may be signs of haemorrhage including tachycardia, hypotension or fall in haemoglobin 4

Psoas haematomas can present with constipation, urinary frequency or fever if they are large. They can even compress the femoral nerve and cause a femoral neuropathy 3-4.

There are many causes for psoas haematomas 1-2:

Ultrasound
  • acute haematoma - low echogenicty; may have a similar appearance to a cyst
  • chronic haematoma - septae formation, calcification or appearance as a solid mass are all features 3
CT
  • may present simply as enlarged psoas muscle
  • acute blood will present as an area of high density +/- fluid-fluid level
  • chronic haematomas may have a similar appearance to psoas abscess 1
MRI

Appearance on MRI depends on the age of the haematoma 2:

  • acute haematoma
    • T1WI - isointense or slightly hypointense to muscle
    • T2WI - may be hypointense or hyperintense
  • subacute haematoma
    • T1WI - high intensity rim, higher intensity peripheral zone and lower intensity core
    • T2WI - relatively higher signal from core to periphery when compared to T1WI
  • chronic haematoma
    • hypointense rim on both T1WI and T2WI

Psoas haematoma can be complicated by superimposed infection or abscess and sometimes percutaneous aspiration and culture can be the only way to differentiate between the two 1

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Article information

rID: 24074
Section: Pathology
Synonyms or Alternate Spellings:
  • Psoas haematomas
  • Psoas muscle haematoma
  • Psoas haemorrhage
  • Psoas major haematoma
  • Psoas hematoma
  • Psoas muscle hematoma
  • Psoas hematomas

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Cases and figures

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    Case 1: post-surgery (CT)
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    Case 1: post surgery (MR)
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    Case 2: haemophilia
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    Case 3: atraumatic
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    Case 4: haemophilia
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    case 5: right - from trauma
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