Hematoma espontáneo del músculo psoas ilíaco secundario a anticoagulación como causa de muerte: reporte de caso / Spontaneous hematoma of the iliac psoas muscle secondary to anticoagulation as cause of death: case report

Resumen El uso de tromboprofilaxis posterior a las cirugías cervicales es una práctica recomendada a nivel mundial debido a que este tipo de pacientes presentan un mayor riesgo de desarrollar tromboembolismos venoso. Dentro de los efectos adversos de esta terapia se ha descrito la epistaxis, hematuria, formación de hematomas y sangrados. El hematoma espontáneo del músculo psoas iliaco, se considera una entidad poco frecuente, que suele asociarse a alteraciones de la coagulación, hemofilia o discrasias sanguíneas y como terapia anticoagulante, siendo este último la principal causa. En la autopsia médico legal, el hematoma del músculo psoas iliaco, suele ser un hallazgo incidental y en la mayoría de casos no contribuye en la causa de muerte. En el presente artículo se expone el caso de un masculino conocido con una enfermedad renal crónica, el cual desarrolló un hematoma espontáneo del músculo psoas iliaco, secundario al uso de enoxaparina como tromboprofilaxis posterior a una intervención quirúrgica en el cuello, que lo condujo a un shock mixto ocasionándole la muerte.

Abstract The use of thromboprophylaxis after cervical surgeries is a recommended practice worldwide due to the fact that these types of patients have a higher risk of developing venous thromboembolisms. Among the adverse effects of this therapy it has been described epistaxis, hematuria, formation of hematomas and bleeding. Spontaneous hematoma of the iliac psoas muscle is considered a rare entity, which is usually associated with coagulation disorders, hemophilia or blood dyscrasias and anticoagulant therapy, the latter being the main cause. In the medico-legal autopsy, the hematoma of the iliopsoas muscle is usually an incidental finding and in most cases does not contribute to the cause of death. This article describes the case of a male known with chronic kidney disease, who developed a spontaneous hematoma of the iliac psoas muscle, secondary to the use of enoxaparin as thromboprophylaxis after a surgical intervention in the neck, which led to a mixed shock causing death.

Split unilateral del nervio femoral a nivel del músculo psoas mayor: reporte de caso / Unilateral femoral nerve split at the psoas major muscle: case report

RESUMEN: El nervio femoral (NF) es el mayor o ramo del plexo lumbar. Normalmente se origina de las divisiones posteriores del segundo al cuarto ramo anterior del plexo lumbar (L2-L4). El músculo psoas mayor tiene su origen a nivel de las vértebras T12 a L5, se fusiona con el músculo ilíaco para luego insertarse en el trocánter menor del fémur. Normalmente, a nivel de la pelvis menor el NF se encuentra entre los músculos ilíaco y psoas mayor. En este trabajo presentamos un caso donde el músculo psoas mayor se relaciona con divisiones o split del NF, esta es una rara variación en la división y curso del NF con relación al músculo psoas mayor. Se observó que el NF se dividía en dos ramos por sobre el plano del ligamento inguinal después de su origen en el plexo lumbar. El NF del lado izquierdo se formó por las ramas ventrales de L2 a L4, a nivel de L5 el nervio es perforado por fascículos del músculo psoas mayor. La división inferior del NF pasaba profundamente a las fibras del músculo iliopsoas y la división superior pasaba superficialmente al músculo psoas mayor y profundo a la fascia ilíaca. Después de un trayecto de 60,21 mm ambas divisiones se unieron, después de atrapar fibras músculo iliopsoas justo inmediatamente proximal al ligamento inguinal para formar el tronco del NF. Si bien las causas embriológicas de las variaciones de los nervios periféricos se remontan a la quinta y sexta semana de vida intrauterina, la expresión clínica de disfunciones neuromusculares aparecerá varios decenios después. De modo que los médicos de las áreas de la traumatología y neurología deben estar al tanto de tales variantes anatómicas para entender mejor el dolor y los síndromes asociados a la compresión nerviosa y durante las maniobras quirúrgicas en esta región.

SUMMARY: AbstractThe femoral nerve (NF) is the major branch (or ramus) of the lumbar plexus. It normally originates from the posterior divisions of the second to fourth anterior branches of the lumbar plexus (L2-L4). The psoas major muscle originates at the level of the T12 to L5 vertebrae, fuses with the iliacus muscle and then inserts into the lesser trochanter of the femur. Normally, at the level of the lesser pelvis, the NF is found between the iliacus and psoas major muscles. In this paper we present a case where the psoas major muscle is related to divisions or splitting of the NF, this is a rare variation in the division and course of the NF in relation to the psoas major muscle. The NF was observed to divide into two branches above the plane of the inguinal ligament after its origin in the lumbar plexus. The NF on the left side was formed by ventral branches from L2 to L4, at the level of L5 the nerve is perforated by fascicles of the psoas major muscle. The lower division of the NF passed deep to the fibers of the iliopsoas muscle and the upper division passed superficial to the psoas major muscle and deep to the iliac fascia. After a path of 60.21 mm both divisions joined, after trapping iliopsoas muscle fibers just immediately proximal to the inguinal ligament to form the NF trunk. While the embryological causes of peripheral nerve variations date back to the fifth and sixth week of intrauterine life, the clinical expression of neuromuscular dysfunctions will appear several decades later. Thus, physicians in the areas of traumatology and neurology should be aware of such anatomical variants to better understand pain and syndromes associated with nerve compression and during surgical maneuvers in this region.

Risks of Sarcopenia in Patients with Hematological and Oncological Factors who Underwent Hematopoietic Stem Cell Transplantation / The Japanese Journal of Rehabilitation Medicine

Background and Aims：Sarcopenia is associated with autologous hematopoietic stem cell transplantation (auto-HSCT) -related outcomes in patients with malignant lymphoma (ML). The aims of this study were to investigate changes in skeletal muscle mass after auto-HSCT and risk profiles for sarcopenia after HSCT.Methods：We enrolled 25 patients with refractory ML (age, 57 years [20-69 years]；female/male, 11/14；body mass index, 21.7 kg/m2 [18.9-29.6 kg/m2]). Skeletal muscle mass was evaluated using the psoas muscle index (PMI) measured on computed tomography before and after auto-HSCT. In addition, visceral fat area (VFA) was also measured. Independent factors and profiles associated with a decrease in PMI were evaluated using multivariate and decision-tree analyses, respectively.Results：The PMI was significantly decreased after auto-HSCT (p＝0.0288). A logistic regression analysis revealed that the decreases in PMI and VFA were related. According to the decision-tree analysis, the PMI measured prior to auto-HSCT was selected as the initial branch. Of the patients with a PMI of＜3.74 cm2/m2, 84％ showed a decrease in PMI. Of the patients with a PMI of ≥3.74 cm2/m2, the VFA measured prior to auto-HSCT was the second branch. All the patients with a VFA of ≥115.0 cm2 had decreased PMI.Conclusions：We demonstrated that skeletal muscle mass decreased after auto-HSCT in the patients with ML. The patients with either a PMI of＜3.74 cm2/m2 or a VFA of ≥105.0 cm2 before auto-HSCT were at risk of decreased skeletal muscle mass.

Risks of Sarcopenia in Patients with Hematological and Oncological Factors who Underwent Hematopoietic Stem Cell Transplantation / The Japanese Journal of Rehabilitation Medicine

Background and Aims：Sarcopenia is associated with autologous hematopoietic stem cell transplantation (auto-HSCT) -related outcomes in patients with malignant lymphoma (ML). The aims of this study were to investigate changes in skeletal muscle mass after auto-HSCT and risk profiles for sarcopenia after HSCT.Methods：We enrolled 25 patients with refractory ML (age, 57 years [20-69 years]；female/male, 11/14；body mass index, 21.7 kg/m2 [18.9-29.6 kg/m2]). Skeletal muscle mass was evaluated using the psoas muscle index (PMI) measured on computed tomography before and after auto-HSCT. In addition, visceral fat area (VFA) was also measured. Independent factors and profiles associated with a decrease in PMI were evaluated using multivariate and decision-tree analyses, respectively.Results：The PMI was significantly decreased after auto-HSCT (p＝0.0288). A logistic regression analysis revealed that the decreases in PMI and VFA were related. According to the decision-tree analysis, the PMI measured prior to auto-HSCT was selected as the initial branch. Of the patients with a PMI of＜3.74 cm2/m2, 84％ showed a decrease in PMI. Of the patients with a PMI of ≥3.74 cm2/m2, the VFA measured prior to auto-HSCT was the second branch. All the patients with a VFA of ≥115.0 cm2 had decreased PMI.Conclusions：We demonstrated that skeletal muscle mass decreased after auto-HSCT in the patients with ML. The patients with either a PMI of＜3.74 cm2/m2 or a VFA of ≥105.0 cm2 before auto-HSCT were at risk of decreased skeletal muscle mass.

A Case of EVAR for Mycotic Aneurysm Rupture / 日本心臓血管外科学会雑誌

We report a case of mycotic aneurysm treated with endovascular aneurysm repair (EVAR). An 80-year-old man was admitted to a local hospital with high fever and lower back pain. Pyogenic spondylitis and psoas muscle abscess were diagnosed. Klebsiella pneumoniae was confirmed by blood culture. Treatment with intravenous antibiotics was not effective and contrast computed tomography (CT) scan showed an enlargement of the abscess and an abdominal aortic rupture. The patient was immediately transferred to our hospital. Laboratory tests showed an elevated C-reactive protein (12.3 mg/dl) and WBC (10,400/μl). Mycotic abdominal aneurysm rupture was diagnosed by CT scan. He underwent an emergency EVAR with an Excluder® (aorta extender). Intraoperative angiography showed a ruptured abdominal aorta. After operation, he was treated with intravenous minocycline and ampicillin, and the size of the abscess reduced without any endoleak on enhanced CT imaging. After intravenous antibiotics therapy for 4 weeks, we switched to oral antibiotics (minocycline and ciprofloxacin) and continued them for 6 months. As of 2 years after the surgery, there are no signs of infection or recurrence.

Isolated psoas schwannoma: A rare retroperitoneal tumor

Retroperitoneal neurogenic tumors are very rare. Isolated or primary psoas schwannoma is one of the rarest tumors of retroperitoneum. The images of such a case are presented in this report.

Relationship between Displacement of the Psoas Major Muscle and Spinal Alignment in Patients with Adult Spinal Deformity

STUDY DESIGN: Cross sectional study. PURPOSE: To clarify the difference in position of the psoas muscle between adult spinal deformity (ASD) and lumbar spinal stenosis (LSS). OVERVIEW OF LITERATURE: Although it is known that the psoas major muscle deviates in ASD patients, no report is available regarding the difference in comparison with LSS patients. METHODS: This study investigates 39 patients. For evaluating spinal alignment, pelvic tilt (PT), pelvic incidence (PI), sacral slope, lumbar lordosis (LL), PI–LL, Cobb angle, and the convex side, the lumbar curves were measured. For measuring the position of the psoas major at the L4/5 disk level, magnetic resonance imaging was used. The displacements of psoas major muscle were measured separately in the anterior–posterior and lateral directions. We examined the relationship between the radiographic parameters and anterior displacement (AD) and lateral displacement (LD) of the psoas major muscle. RESULTS: AD was demonstrated in 15 cases with ASD and nine cases with LSS (p>0.05). LD was observed in 13 cases with ASD and no cases with LSS (p < 0.01). The Cobb angle was significantly greater in cases with AD than in those without AD (p=0.04). PT, LL, PI–LL, and Cobb angle were significantly greater in cases with LD (p < 0.05). All cases with LD had AD, but no case without AD had LD (p < 0.001). The side of greater displacement at L4/5 and the convex side of the lumbar curve were consistent in all cases. CONCLUSIONS: Despite AD being observed in LSS as well, LD was observed only in the ASD group. Radiographic parameters were worse when LD was seen, rather than AD.

Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis

BACKGROUND/AIMS: The most widely used method for diagnosing sarcopenia is the skeletal muscle index (SMI). Several studies have suggested that psoas muscle thickness per height (PMTH) is also effective for detecting sarcopenia and predicting prognosis in patients with cirrhosis. The aim of this study was to evaluate the optimal cutoff values of PMTH for detecting sarcopenia in cirrhotic patients. METHODS: All cirrhotic patients who underwent abdominal computed tomography (CT) scan including L3 and umbilical levels for measuring SMI and transverse psoas muscle thickness, respectively, were included. Two definitions of sarcopenia were used: (1) sex-specific cutoffs of SMI (≤52.4 cm² /m² in men and ≤38.5 cm² /m² in women) for SMI-sarcopenia and (2) cutoff of PMTH ( < 16.8 mm/m) for PMTH-sarcopenia. RESULTS: Six hundred fifty-three patients were included. The average age was 53.6 ± 10.2 years, and 499 patients (76.4%) were men. PMTH correlated well with SMI in both men and women (P < 0.001). Two hundred forty-one (36.9%) patients met the criteria for SMI-sarcopenia. The best PMTH cutoff values for predicting SMI-sarcopenia were 17.3 mm/m in men and 10.4 mm/m in women, and these were defined as sex-specific cutoffs of PMTH (SsPMTH). The previously published cutoff of PMTH was defined as sex-nonspecific cutoff of PMTH (SnPMTH). Two hundred thirty (35.2%) patients were diagnosed with SsPMTH-sarcopenia, and 280 (44.4%) patients were diagnosed with SnPMTH-sarcopenia. On a multivariate Cox regression analysis, SsPMTH-sarcopenia (hazard ratio [HR], 1.944; 95% confidence interval [CI], 1.144–3.304; P=0.014) was significantly associated with mortality, while SnPMTH-sarcopenia was not (HR, 1.446; 95% CI, 0.861–2.431; P=0.164). CONCLUSIONS: PMTH was well correlated with SMI in cirrhotic patients. SsPMTH-sarcopenia was an independent predictor of mortality in these patients and more accurately predicted mortality compared to SnPMTH-sarcopenia.

Impact of psoas muscle index on early postoperative mortality and complications after liver transplantation / 中华外科杂志

Objective@#To investigate the relationship between psoas muscle index (PMI) and early postoperative survival rate and the incidence of complications after liver transplantation in adults.@*Methods@#The clinical data of 225 patients (male, n=184; female, n=41) underwent liver transplantation at the Organ Transplantation Department of First Central Clinic Institute of Tianjin Medical University from January 2014 to December 2016 were analyzed, retrospectively.Original disease: hepatitis B liver cirrhosis(44 cases), hepatitis C cirrhosis(10 cases), autoimmune liver cirrhosis(29 cases), other benign liver diseases(24 cases), liver cirrhosis with liver cancer(116 cases), hilar cholangiocarcinoma(1 case) and hepatic vascular sarcoma(1 case). The area of bilateral psoas muscle on the lower edge level of the third lumbar vertebral body was measured through preoperative CT image.The PMI was calculated using this formula: bilateral psoas muscle area (mm2)/the square of the body height (m2). According to the receiver operating characteristic curve and cut-off values, the male and female patients were divided into low PMI group and high PMI group respectively.The χ2 test, Fisher exact test and t-test was used to compare the differences in perioperative data, survival rate and postoperative complications between the two groups, respectively.@*Results@#There were 44 patients in the low PMI group, and 181 patients in the high PMI group. ICU time was longer (82.5(62.0-128.0) hours vs.69.1(56.0-104.0) hours; P=0.006) and preoperative blood urea nitrogen level (5.86(4.35-15.52) mmol/L vs. 4.94(4.05-7.06) mmol/L; P=0.012) was higher in the low PMI group than those in the high PMI group. Incidence rates of grade 5 complication (18.2%) and grade 4a complication (18.2%) were higher in the low PMI group, and 120-day cumulative survival rate was lower than that in high PMI group(81.8% vs. 95.6%, P=0.001). On the other hand, there were no significant differences in preoperative white blood cell count level, serum creatinine level, operative time, anhepatic period time, intraoperative blood loss, and incidence of postoperative grade 3 complications between the two groups(all P>0.05).@*Conclusions@#There is a significant correlation between PMI and early postoperative survival rate and incidence of complications.Patients with lower PMI has poor prognosis after liver transplantation.

A brief report on a technical description of ultrasound-guided lumbar sympathetic block

The lumbar sympathetic ganglion block (LSGB) is widely used for diagnosing and treating sympathetically maintained pain disorders. The LSGB has been conventionally carried out under fluoroscopy or computed tomography guidance. However, as ultrasound technology improved, ultrasound-guided interventions have been expanding their territory to deeper structures. Ultrasound guidance provides many benefits including protecting vascular injection, shortening procedure time in some cases, and reducing the emission of radiation. In this report, we describe a successful case of a US-guided LSGB without major complications. We expect that US-guided LSGBs can be implemented and furnished in the daily outpatient clinical setting by highly trained pain physicians.

Treatment of osteonecrosis of the femoral head by botulinum toxin type A injection to the psoas muscle: A case report

Osteonecrosis of the femoral head (ONFH) can cause femoral head depression and cortical discontinuity. Treatment for ONFH remains challenging. We performed botulinum toxin type A injection to psoas major muscle in five patients with radiological femoral head collapse (Association Research Circulation Osseus classification stage III) who were non-responsive after two years of conservative treatment (tramadol 200 mg/day, mefenamic acid 1,000 mg/day). At two weeks after the procedure, their mean hip pain was decreased from 88 ± 0.4/100 mm to 22 ± 0.4/100 mm based on visual analogue scale (VAS). The pain was maintained at a minimum of 20/100 mm and a maximum of 30/100 mm in VAS for at least six weeks after the procedure. These values were mean ± SD. These patients were followed-up for 6 months. There was no exacerbation of pain from repeated (three times) botulinum toxin type A injection to the psoas major muscle.

An Unusual Venous Plexus on Psoas Major Muscle Connecting the Inferior Mesenteric and Testicular Veins

Knowledge of communication between parietal abdominal veins, testicular vein and mesenteric veins is important for Surgeons, Urologists and Radiologists. These communications can result in varicocele or hemorrhoids and may lead to low success rate in hemorrhoid and varicocele surgeries. During routine dissection classes, we observed an unusual large venous plexus on the left psoas major muscle. The venous plexus was unilateral and was formed by many anastomotic venous channels on the psoas fascia and communicated with the left testicular and inferior mesenteric veins. The testicular and inferior mesenteric veins were significantly enlarged below the level of communication with the venous plexus.

Espondilodiscitis a germen inusual: análisis de un caso clínico y revisión de la bibliografía / Spondilodiscitis caused be an unusual organism: clinical case report and literature review

La espondilodiscitis infecciosa es una entidad poco frecuente que afecta el disco intervertebral y las vértebras adyacentes. Su importancia clínica radica en la morbilidad que determina. En este caso nos centraremos en la espondilodiscitis piógena (EP) y, dentro de ella, en la estreptocócica. Se presenta el caso clínico de un paciente con espondilodiscitis por Streptoccocus intermedius perteneciente al grupo viridans, se analizan las características clínicas, y se realiza una breve revisión bibliográfica.

Infectious spondylodiscitis is a rare condition that affects the intervertebral disc and adjacent vertebrae. Its clinical relevance is related with its morbidity. In this case we will focus on the pyogenous spondylodiscitis (PS), and more specifically, streptococcal. Clinical case report of a patient with spondylodiscitis caused by Streptoccocus intermedius of the viridans group, with a description of the clinical features and a brief literature review.

Sarcopenia as a Useful Predictor for Long-Term Mortality in Cirrhotic Patients with Ascites

This study aimed to assess and compare sarcopenia with other prognostic factors for predicting long-term mortality in cirrhotic patients with ascites. Clinical data of 65 among 89 patients with measurement of all parameters were consecutively collected. Sarcopenia was evaluated as right psoas muscle thickness measurement divided by height (PMTH) (mm/m). During a mean follow-up of 20 (range: 1-49) months, 19 (29.2%) of 65 patients died. The values of the area under the receiver operating characteristics curve (AUROC) of Child-Pugh score, Model for End-Stage Liver Disease (MELD) score, MELD-Na, and PMTH for predicting 1-yr mortality were 0.777 (95% CI, 0.635-0.883), 0.769 (95% CI, 0.627-0.877), 0.800 (95% CI, 0.661-0.900), and 0.833 (95% CI, 0.699-0.924), whereas hepatic venous pressure gradient was not significant (AUROC, 0.695; 95% CI. 0.547-0.818, P=0.053). The differences between PMTH and other prognostic variables were not significant (all P>0.05). The best cut-off value of PMTH to predict long-term mortality was 14 mm/m. The mortality rates at 1-yr and 2-yr with PMTH>14 mm/m vs. PMTH14 mm/m (HR, 5.398; 95% CI, 2.111-13.800, P<0.001). In conclusion, sarcopenia, evaluated by PMTH, is an independent useful predictor for long-term mortality in cirrhotic patients with ascites.

Neuropatia do nervo femoral após psoas hitch / Femoral nerve neuropathy after the psoas hitch procedure

A neuropatia do nervo femoral como complicação de cirurgia abdominopélvica foi descrita, pela primeira vez, em 1896, por Gumpertz, em um relato de caso de lesão do nervo femoral após histerectomia. Os autores relatam dois casos de neuropatia do nervo femoral após reimplantação ureteral, com técnica de psoas hitch em vesicopexia, e discutem a etiologia e as manifestações clínicas dessa complicação. A neuropatia do nervo femoral secundária à técnica de psoas hitch é uma complicação rara, embora deva ser levada em consideração durante o procedimento cirúrgico, bem como no cuidado pós-operatório.

Femoral nerve neuropathy as a complication from abdominopelvic surgery was firstly described in 1896, by Gumpertz, in a case report of femoral nerve injury following hysterectomy. The authors report two cases of femoral nerve neuropathy following psoas hitch vesicopexy in ureteral reimplantation, and to discuss the etiology and clinical manifestations of this complication. Femoral nerve neuropathy secondary to psoas hitch is a rare complication, although it should be considered during the surgical procedure, as well as in postoperative care.

Recurrent Malignant Fibrous Histiocytoma in Psoas Muscle: A Case Report

Malignant fibrous histiocytoma is one of the most common sarcomas that occur in soft tissue, it usually develops in old age individuals and the incidence is similar between the genders. We report here on a case with invasive local recurrence after surgical resection of a malignant fibrous histiocytoma that occurred in the left psoas muscle of a 69-year-old male patient. The patient was first admitted to our hospital with a primary lesion in the left lower abdomen, as seen on magnetic resonance imaging. We report here on a rare case of a malignant fibrous histicytoma in the psoas muscle.

Comparison of Multilevel with Single Level Injection during Lumbar Sympathetic Ganglion Block: Efficacy of Sympatholysis and Incidence of Psoas Muscle Injection

BACKGROUND: We prospectively evaluated the incidence and possible factors causing intramuscular injection during lumbar sympathetic ganglion block and compared the multiple needle technique to the single technique to obtain a profound and complete block effect. METHODS: Among 83 patients, 58 patients (group A, n = 27, multiple needle technique and group B, n = 31, single needle technique) were reevaluated for the changes of skin temperature (Ts) and mean segment of longitudinal contrast spread. After injecting the contrast agent, the incidence of psoas muscle injection and the change of Ts was compared between two groups. RESULTS: The incidence of psoas muscle injection was 21.3% (46/216) and it was associated with the level of injection (L2) significantly (chi-square = 14.773, P = 0.001). DT(post) (postblock temperature difference between ipsilateral and contralateral great toe, 4.6 +/- 2.8degrees C, 1.8 +/- 1.6degrees C, P < 0.001 for group A and B) and DT(net) (DT(post) - DT(pre), 3.9 +/- 2.7degrees C, 1.5 +/- 1.5degrees C, P < 0.001 for group A and B) was significantly higher in group A. The mean segment of longitudinal contrast spread was 8.1 +/- 0.9 for group A and 3.2 +/- 1.6 for group B (P < 0.001). CONCLUSIONS: The LSGB at the L2 level showed the lowest incidence of psoas muscle injection of contrast. Multiple needle approach showed more significant increase of DT(net) and DT(post).

Clinical Availability, Diagnosis and Treatment of the Primary Psoas Muscle Abscess

STUDY DESIGN: This is a retrospective study on the clinical availability, diagnosis and treatment of primary psoas muscle abscess. OBJECTIVES: This study investigated the causes and clinical results of patients with primary psoas muscle abscess. SUMMARY OF LITERATURE REVIEW: Primary psoas muscle abscess is not a common disease clinically, but it is a very dangerous disease if the diagnosis and treatment are delayed. MATERIALS AND METHODS: Between October 2003 and February 2010, we investigated the symptoms, pathogens, the associated diseases and treatments of 17 patients (11 males and 6 females; mean age: 49.5 years old). We divided patients into the 3 groups According to the treatment options (Group 1: antibiotics alone, Group 2: percutaneous catheter drainage, Group 3: open drainage) and the correlation of the abscess size of each group was analyzed by the Kruskall Wallis method. RESULTS: The most common complaint was lower back pain (14 patients). Staphylococcus aureus was the most common infectious organism (12 patients). All the patients were treated with broad spectrum antibiotics. Group 1 was composed of 4 patients and the average size of the abscess was 2.3cm (range: 1.2~4.5cm). Group 2 was composed of 7 patients and the average size of the abscess was 7.4cm (range: 3.8~12.2cm). Group 3 was composed of 6 patients and the average size of the abscess was 8.1cm (range: 6.1~14.7cm). There was a significant correlation of the abscess size between each group. (p=0.0007) CONCLUSIONS: The patients diagnosed with primary psoas muscle abscess complained about lower back pain, a febrile sense and gastrointestinal symptoms. Most of the primary psoas muscle abscesses are pyogenic infections. We have to use broad-spectrum antibiotics for the initial treatment. When the occasion demands, additional treatment like percutaneous catheter drainage and open drainage should be considered.

Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy

We present a case of an acute psoas muscle hematoma following percutaneous endoscopic lumbar discectomy. A 60-year-old female who presented with far lateral lumbar disc herniation underwent endoscopic discectomy on the right side at the L4-5 level. On the second postoperative day, the patient complained of severe right flank and leg pain and her blood pressure decreased. A computed tomography scan showed a large acute psoas muscle hematoma at right L4-5 level. The patient was transfused with packed red blood cells and placed at absolute bed rest. After observing the patient in intensive care, the severe flank and leg pain subsided, but the mild back pain persisted. Although percutaneous endoscopic lumbar discectomy is an effective minimally invasive surgical technique for the treatment of lumbar disc herniation, this case highlights the inherent risks of acute lumbar segmental vessel injury.

Patologias do compartimento iliopsoas: avaliação radiológica / Iliopsoas compartment lesions: a radiological evaluation

Limite posterior do retroperitônio, o compartimento iliopsoas localiza-se externamente ao mesmo, sendo composto dos músculos psoas maior, psoas menor e ilíaco. O quadro de sintomas dos pacientes com acometimento patológico deste compartimento é amplo e inespecífico, podendo haver importante atraso no diagnóstico. Entretanto, na busca do diagnóstico etiológico das alterações do compartimento iliopsoas, sabemos que as infecções, os tumores e as hemorragias respondem pela quase totalidade das lesões. Por meio da avaliação retrospectiva de exames radiológicos de pacientes com patologias do iliopsoas e que tiveram o diagnóstico confirmado por exame anatomopatológico ou acompanhamento clínico, revisamos a anatomia deste compartimento, assim como as suas principais formas de acometimento, identificando sinais que auxiliem na diferenciação dos potenciais diagnósticos diferenciais. Na abordagem de cada patologia discutiremos os principais sinais radiológicos, como a presença de gás em abscessos piogênicos, alterações ósseas em corpos vertebrais nas lesões secundárias a tuberculose, comprometimento dos planos fasciais nas lesões tumorais e diferenças na densidade e intensidade de sinal dos hematomas nas diferentes fases de degradação da hemoglobina, entre outros. Dessa forma, procuramos apresentar casos que exemplifiquem as doenças mais freqüentes do compartimento iliopsoas, destacando a importância dos seus diferentes sinais, aproximando-nos de um diagnóstico etiológico específico.

The iliopsoas compartment, a posterior boundary of the retroperitoneum, is comprised of the psoas major, psoas minor and iliac muscles. The symptoms picture in patients presenting with pathological involvement of this compartment may show a wide range of nonspecific clinical presentations that may lead to delayed diagnosis. However, in the search of an etiological diagnosis, it is already known that inflammation, tumors, and hemorrhages account for almost all the lesions affecting the iliopsoas compartment. By means of a retrospective analysis of radiological studies in patients with iliopsoas compartment lesions whose diagnosis was confirmed by anatomopathological evaluation or clinical follow-up, we have reviewed its anatomy as well as the main forms of involvement, with the purpose of identifying radiological signs that may help to narrow down the potential differential diagnoses. As each lesion is approached we will discuss the main radiological findings such as presence of gas in pyogenic abscesses, bone destruction and other bone changes of vertebral bodies in lesions secondary to tuberculosis, involvement of fascial planes in cases of neoplasms, and differences in signal density and intensity of hematomas secondary to hemoglobin degradation, among others. So, we have tried to present cases depicting the most frequent lesions involving the iliopsoas compartment, with emphasis on those signs that can lead us to a more specific etiological diagnosis.