Presentation
Patient presented with acute on chronic back pain. No history of trauma. Sudden onset of sharp pain left side of back, unable to weight bear on left leg, sensory deficits of left lower limb. Lumbosacral CT performed given patients symptoms with nerve root compression a main differential.
Patient Data
Increased density and stranding seen adjacent to the left iliopsoas muscle consistent with a retroperitoneal iliopsoas hematoma.
CT angiogram shows multiple streaks of contrast blush in the vicinity of the left iliopsoas hematoma.
Delayed phase shows pooling (increased size of blush) of contrast.
Findings consistent with active bleeding from stripping of surrounding small vessels secondary to hematoma.
Case Discussion
In this case the iliopsoas hemorrhage was due to warfarin leading to supratherapeutic INR.
Symptoms of pain, inability to weight bear and sensory deficits can be explained by the mass effect exerted by the hematoma.
In cases of large iliopsoas hematomas femoral nerve may be compressed producing femoral nerve neuropathy.
Fortunately for the patient he remained haemodynamically stable and the findings on CTA were consistent with only small ongoing bleed which was safely managed with reversal of anticoagulation and did not require intervention.
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