PMC10173832_01
Right traumatic iliopsoas hemorrhage in a 54-year-old man with right flank pain and right flexion hip contracture after falling to the ground. (a) Transverse view on ultrasonography 5 h after a trauma, obtained at the level of the iliac crest, shows a large circumscribed mass within the right abdomen. The internal contents are predominantly hypoechoic. The normal right iliopsoas muscle is not visible. (b) Longitudinal view on ultrasonography reveals a predominantly hypoechoic lesion (arrows). (c) Transverse view on contrast-enhanced multidetector computed tomography of the abdomen, at the level of the umbilicus, reveals a hematoma within the swollen right psoas major muscle and the right retroperitoneal space (arrowheads). The hematoma also extended downward to the right iliacus muscle (not shown). Anteromedial displacement of the right ureter (arrow) by the hematoma is also noted. (d) Coronal view on contrast-enhanced multidetector computed tomography of the abdomen shows the hematoma within the swollen right psoas major muscle and within the right retroperitoneal space (arrowheads). There is no extravasation of contrast. LS: Lumbar spine, PM: Psoas major
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F1
US revealed a large hypoechoic mass, without detectable vascularity on Doppler, within the right paravertebral area [Figure 1a and b]. US also showed coarse echogenicity of the liver and splenomegaly compatible with liver cirrhosis complicated by portal hypertension. The diagnosis of iliopsoas hemorrhage was suspected and later confirmed by subsequent multidetector computed tomography (MDCT) [Figure 1c and d].
PMC10173832_02
Left traumatic iliopsoas hemorrhage in a 34-year-old man with severe low back pain and incomplete left femoral nerve palsy after a motorcycle accident. (a) Transverse view on ultrasonography 9 h after a trauma, obtained at the level just above the iliac crest, shows fusiform enlargement of the left iliopsoas muscle with mixed echogenicity in a mosaic (starry) pattern. (b) The corresponding color Doppler image, obtained with a color velocity setting of 27 cm/s, demonstrates no detectable blood flow within the lesion. (c) Longitudinal view on ultrasonography reveals multiple hyperechoic lines parallel to each other within the lesion pathognomonic for muscular hemorrhage after trauma. (d) Transverse view on contrast-enhanced multidetector computed tomography of the abdomen, obtained at the level of the aortic bifurcation, reveals a hematoma within a swollen left psoas major as well as hematoma of the left quadratus lumborum and erector spinae muscles. Fracture of the left transverse process of L4 vertebra (arrows) is also shown. Note the minimal contrast medium extravasation (arrowhead) close to the fractured bone. (e) Transverse view on contrast-enhanced multidetector computed tomography of the pelvis reveals downward extension of the hematoma into the left iliacus (I) muscle. AA: Abdominal aorta, LS: Lumbar spine, PM: Psoas major
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F2
On transverse view, fusiform enlargement of the left iliopsoas muscle with mixed echogenicity in a mosaic (starry) pattern was noted [Figure 2a]. There was no detectable flow within the swollen muscle on Doppler US [Figure 2b]. The longitudinal view showed multiple hyperechoic lines parallel to each other within the lesion [Figure 2c]. MDCT [Figure 2d and e]. MDCT also revealed fractures of the left transverse processes of T12-L4 vertebrae.