Case 1
A 24-year-old man fell backward to the ground while snowboarding. He immediately felt right groin pain, but was able to continue snowboarding. Approximately 5 h after falling, he complained of severe right groin pain and difficulty in walking. He visited an emergency department on the very same day. No other significant medical history was elicited.
On examination, he was alert. Blood pressure was 149/75 mmHg, heart rate was 70 beats/min, and temperature was 37.6°C. He manifested flexion hip contracture on the right side, showing difficulty in extending the right hip due to the severe pain. Abdominal examination detected tenderness in the right lower quadrant. Results of neurological examination were unremarkable for both the lower limbs. Given his history and the findings of physical examination, iliopsoas hematoma was suspected.
Point-of-care ultrasound identified diffuse swelling of the right psoas major compressing the right kidney, compatible with a diagnosis of iliopsoas hematoma (Fig. 1). The internal echo was heterogeneous. Ultrasound was performed using curved 3.75-MHz phased-array transducers (SSA-240A; Toshiba, Tokyo, Japan). A subsequent CT confirmed the presence of iliopsoas hematoma.
The patient was treated conservatively and experienced no sequelae.
Case 2
A 74-year-old woman developed severe left lower quadrant and left groin pain 2 days after falling down. The following day, she visited an emergency department. Her medical history included compression fracture of the lumbar vertebrae, donor nephrectomy, and transurethral resection of a bladder tumor. She had no history of taking antiplatelet or anticoagulant agents.
On examination, the patient was alert. Blood pressure was 154/98 mmHg, heart rate was 79 beats/min, and temperature was 37.4°C. This patient also manifested flexion hip contracture, on the left side. Abdominal examination detected tenderness, mainly in the left lower quadrant, and a palpable mass accompanied by tenderness was identified lateral to the left femoral artery. The neurological examination yielded unremarkable results for both the lower limbs.
Point-of-care ultrasound identified diffuse swelling of the left psoas major adjacent to the spinal column and swelling of the iliopsoas musculotendinous unit at the level of the groin (Fig. 2). Ultrasound was performed using curved 3.8-MHz phased-array transducers (LOGIQ BooK XP; GE, Wisconsin, USA). Subsequent CT confirmed the presence of iliopsoas hematoma.
The patient was also treated conservatively.