IIeopsoas muscle haematoma
19 years old haemophilic young man with right abdominal pain and swelling.
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- Large right ileo-psoas muscle heterogenous, 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.
Right ileo-psoas non-enhancing haemorrhagic mass lesion; consistent with ileopsoas haematoma (haemophilic pseudotumor), in the clinical sitting of bleeding diathesis with haemophilia.
The main differential diagnosis of iliopsoas haematoma (haemophilic pseudotumor) is :
- Ileopsoas abscess : marginally enhancing lesion usually through local spread from a nearby infection e.g. TB spinal spondylodiscitis, perinephric abscess , appendicitis, divericulitis, Crohn's disease or perforated colonic carcinoma that is 2ry infected. primary iliopsoas abscesses are rare and mostly in immunocompromised patients.
- Ileopsoas tumors : sarcoma is most likley with the presence of heterogenous enhancement, lymphadenopathy, bone destruction, and extension across the retroperitoneal facial planes are favouring the diagnosis of ileopsoas malignant mass. Ilipsoas metastases are rare; with the primary could be breast, ovary,cervical carcinoma, lung, lymphoma and melanoma.