Presentation
Four days post-op for colectomy for previous bowel cancer. Increased LIF pain, tender firm area on palpation ?collection ?infection
Patient Data
Marked enlargement of the iliopsoas muscles on the left is now apparent with heterogeneity. This may represent a developing psoas abscess though if the patient is anticoagulated, a hemorrhage into the muscles is also a possibility.
The fluid collection previously identified just superior to the dome of the bladder adjacent to the sigmoid colon. Small fluid collection related to the midline abdominal incision superior to the umbilicus
Within the left psoas muscle there is a loculated mass extending from the L3 level to the pelvis, measuring 10 x 3.5 x 3cm. This demonstrates intrinsic peripheral high T1 signal, low internal T2 signal with post contrast rim enhancement. There is no internal enhancement. There is extension laterally of a component into quadratus lumborum. Within the right psoas muscle there is a smaller lesion of the similar signal characteristics measuring 1.1 x 1.2 x 2.3cm (at L4-5 level).
Gas-containing collection anterior to the uterus, preseumbly post-operative is seen on prior CT.
Incidental note of left ovarian cystic lesion.
Conclusion:
Findings in keeping with bilateral subacute psoas hematomas, larger on the left. No specific features of superinfection. High clinical suspicion may prompt percutaneous aspiration.
Case Discussion
The treating team were not suspicious for a superimposed infection (so no aspiration for culture was performed) and no cause (the patient was not anticoagulated) has been determined thus far for the cause of the bilateral psoas hematomas but it is presumed to be secondary to the recent surgery.
The key differential for this case is psoas abscess.
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