Korean J Neurotrauma.  2019 Oct;15(2):234-238. 10.13004/kjnt.2019.15.e29.

Intramuscular hematoma on the psoas muscle

• Seo JG
• Yang JC
• Kim TW
• Park KH

• KMID: 2461134
• DOI: http://doi.org/10.13004/kjnt.2019.15.e29

Abstract

Intramuscular hematomas on the psoas muscle are rare and usually occur as a result of trauma, iatrogenic etiology during lumbar surgery, rupture of the aortic aneurysm, and hematologic diseases. The incidence of spontaneous psoas muscle hematomas has slowly increased as a result of using anticoagulation and antiplatelet agents. Magnetic resonance (MR) imaging is a more sensitive option compared to computed tomography (CT) when diagnosing a hematoma. Coronal T2-weighted images are more useful. CT imaging is also useful to establish the rapid diagnosis of hematoma. When a prolonged prothrombin time and international normalized ratio and decrease platelet count are noted, psoas muscle hematomas should be considered, if there was no lesion in the spinal canal. Most hematomas resolve spontaneously without clinical complications if the hematoma is not large or it is not compressing the surrounding important structures, irrespective of cause.

Keyword

Psoas muscles; Hematoma; Magnetic resonance imaging; Tomography

MeSH Terms

Aortic Aneurysm
Diagnosis
Hematologic Diseases
Hematoma*
Incidence
International Normalized Ratio
Magnetic Resonance Imaging
Platelet Aggregation Inhibitors
Platelet Count
Prothrombin Time
Psoas Muscles*
Rupture
Spinal Canal
Platelet Aggregation Inhibitors

Figure

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  FIGURE 1 Magnetic resonance imaging reveals an oval-shaped mass lesion in the left psoas muscle. T2 coronal (A, white arrow), T2 axial (B), and T1 axial (C, white arrow) image. Various signal intensities within the hematoma, named mosaic sign (B, white arrow head).

• 

  FIGURE 2 Three weeks later, computed tomography imaging reveals nearly complete absorption of the hematoma. Coronal (A) and axial (B) image.

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  FIGURE 3 Magnetic resonance imaging without enhancement shows heterogeneous signal intensity mass with peripheral high intensity rim in both psoas muscles. T1 coronal (A, white arrows), T2 axial (B, white arrows), and T1 axial (C, white arrows) image.

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  FIGURE 4 Four weeks later, magnetic resonance imaging reveals decreased hematoma size in both psoas muscles. T2 coronal (A) and T2 axial (B) image.

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