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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.
Coronal MRI Scan of the Abdomen and Pelvis: Note the large mass on the left. Also note the normal anatomic structures (1 - femoral neck / hip; 2- ilium; 3 - iliacus muscle; 4 - psoas muscle; 5 - kidney; 6 - lumbar spine. 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.
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