Presentation
This 25 year old male was stabbed in the right thoracic back area. He lost approximately 1 liter of blood, and was hypotensive on arrival to the hospital. A CT Trauma Series was performed.
Patient Data
- Right psoas hematoma as described secondary to penetrating injury with a small amount of retroperitoneal hematoma anterior to the psoas. No evidence of renal parenchymal, vascular injury or CT evidence of active bleeding.
Case Discussion
Psoas hematomas can occasionally occur after trauma, where a build up of blood occurs in the retrofascial space. The psoas muscles are placed posterior to the transversalis fascia, so technically sits outside the peritoneum.
Psoas hematoma is usually associated with direct blunt trauma to the back and flank. They can be associated with a large degree of hemorrhage which is clinically difficult to detect, due to the retrofascial site of the hemorrhage. It is recommended that the patient's hemoglobin level be monitored for at least 2 days post trauma1, as a large amount of blood can be lost within this large muscle.
Injuries associated with psoas hematoma include ureteral compression and nerve compression. In these cases, operative decompression would be undertaken. Usually, conservative monitoring is the treatment of choice.
In this patient, note the bulky right psoas muscle which is much more heterogeneous in comparison the left sided psoas. This is due to the extravasation of blood from the original traumatic event.
Case contributed by A/Prof. Pramit Phal.