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Clinical picture showing mass in the right lower abdomen.
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There were bilateral hip flexion deformities because of pain (Fig. 1).
(A) MRI T1-weighted image axial plane with contrast showed heterogenic intensity lesion with clear border and septation (arrow). (B) MRI T1-weighted image sagittal plane showed hyperintense heterogenic lesion with hypointense rim encircling the mass and slight cranial shift of right kidney and bowel (arrow). (C) MRI T1-weighted image coronal plane showing mass on right iliopsoas muscle.
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There was also mass with the same intensity in left pelvic region, sized 4.2 x 4.7 x 5.9 cm that shifted left psoas muscle slight anteriorly (Fig. 2).
Intraoperative finding of the right mass (A, B) and left mass (C, D). (A) Exposed mass with right lateral femoral cutaneous nerve crossing the tumor. (B) Incision of the capsule showed dark red haematoma with soft and springy consistency. (C) After the evacuation of haematoma and excision of capsule, preservation of right lateral femoral cutaneous nerve and preservation of iliopsoas muscle. (D) Application of fibrin glue. (For interpretation of the references to color in the text as well as in the figure legend, the reader is referred to the web version of this article.)
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After the mass was seen, we opened the capsule and then we evacuated the haematoma (Fig. 3). After that, the same procedure was done to the second pseudotumour at left iliopsoas muscle (Fig. 3).
(A) Postoperative histopathology (haematoxylin eosin, 100x magnification) showing haemorrhage at the central of pseudotumour, no tumour cell was found. (B) Gross pathology of the mass excised.
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Postoperative histopathology showed haemorrhage, reactive osteoid, and fibrous tissue that confirmed the clinical diagnosis of haemophilic pseudotumour (Fig. 4).
After three months follow up, patient was able to stand up on his left foot with being assisted.
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The muscle power of his lower limb especially the left side improved to score 4/5 and he was able to stand up assisted for about 10-20 s (Fig. 5).