<% strPathPics = Session("strPathPicsL") imgBg = strPathPics + Session("strMedia") %> Retro2

Retroperitoneal Hematoma and Lumbar Plexopathy - Case 2

An 38 old-man developed a DVT and was treated with lovenox. Over two days, he developed pain in his groin followed by numbness over the left anterior thigh associated with his knee buckling. His hematocrit fell from 36 to 25. Her patellar reflex on the right was 2+ and absent on the left. Ankle jerks were normal bilaterally.

Show the Hematoma                    Show the Psoas Muscles                    Show the Iliacus Muscle

Axial CT Scan of the Abdomen and Pelvis:  Note the large mass on the left. This is a retroperitoneal hematoma posterior to the psoas muscle. Spontaneous retroperitoneal hemorrhage into the psoas muscle is often associated with coagulopathies (e.g., excessive anticoagulation, hemophilia, etc.). The hematoma places pressure on the underlying lumbar plexus, resulting in weakness of hip flexion (iliopsoas), knee extension (quadriceps) and hip adduction (thigh adductors). The knee reflex is typically depressed. Sensory loss may be present over the anterior thigh, medial thigh, and/or medial calf. Pain often interferes with assessment of muscle strength.

Revised 04/26/06.
The Electronic Curriculum is copyrighted 1998,  Case Western Reserve University School of Medicine.