Clinical History
Abdominal pain after lumbar trauma
Imaging Findings
A 33 year old female involved in a car accident presented with abdominal pain and anemia. US and CT were performed showing an hematoma involving the left psoas muscle and the left pararenal space.
Discussion
The psoas muscle and the pararenal space may be primary affected in many pathological process and also they may be involved by diseases originating in adjacent retroperitoneal structures.
Retroperitoneal hemorrage, due to rupture of aortic aneurysm, chronic use of anticoagulants, pelvic fracture, traumatic lesions of parenchymal organs, invasive diagnostic procedures, shapes the picture of the retroperitoneal hematoma.
Symptoms depend on the cause and the entity of the bloody loss. Retroperitoneal hemorrage is the cause of anemia and hypovolemic shock because of the retroperitoneal space may act as a reservoir, and large quantities of blood may be accumulated within the space.
Generally pain is present due to nerve and peritoneal plexi stimulation or distension.
Lately can be observed ecchimothic areas at lumbar level, along the flanks and at the bottom of the scrotum (Clibert's sign).
Therapy is causal; evolution and prognosis depend on early diagnosis of the cause.
Retroperitoneal hemorrage may be difficult to prove, particularly in patient without a history of anticoagulation therapy or trauma. A retroperitoneal hematoma is demonstrable by CT as an abnormal mass obliterating the retroperitoneal space that can explain patient's drop in hematocrit.
Differential Diagnosis List
Psoas and pararenal space hematoma
Final Diagnosis
Psoas and pararenal space hematoma
