Bilateral psoas haematomas

Case contributed by Dr Henry Knipe

Presentation

Four days post-op for colectomy for previous bowel cancer. Increased LIF pain, tender firm area on palpation ?collection ?infection

Patient Data

Age: 65
Gender: Female
CT

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 haemorrhage 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

MRI

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 haematomas, 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 haematomas but it is presumed to be secondary to the recent surgery. 

The key differential for this case is psoas abscess

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Case information

rID: 24057
Case created: 26th Jul 2013
Last edited: 15th Nov 2016
Inclusion in quiz mode: Included

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