Iliopsoas compartment: normal anatomy and pathologic processes.

Torres, Gladys M.; Cernigliaro, Joseph G.; Abbitt, Patricia L.; Mergo, Patricia J.; Hellein, V. F.; Fernandez, S.; Ros, Pablo R.

doi:10.1148/radiographics.15.6.8577956

Cited by 93 publications

(64 citation statements)

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“…It has been hypothesized that diffused occult vasculopathy and arteriosclerosis of the small vessels in the retroperitoneum may render them friable and therefore prone to rupture, although such theories have not yet been substantiated on histological examination (17). Qanadli et al reported that spontaneous bleeding starts at the microvascular level, and large vessels are stretched or ruptured as the hematoma enlarges (18).…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Hematoma in a Patient with Advanced Chronic Kidney Disease Receiving Warfarin Therapy

et al. 2016

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A 73-year-old man with chronic kidney disease stage G5 was admitted to our hospital because of a worsening kidney dysfunction. He had undergone prosthetic valve replacement of the mitral valve 5 years previously and was currently taking warfarin. He showed excessive anticoagulation on admission, with a prothrombin time-international normalized ratio (PT-INR) of 3.91. The use of warfarin was ceased and PT-INR decreased to 2.1. Since the patient would need renal replacement therapy, he underwent arteriovenous fistula surgery for hemodialysis access on day 16. However, on day 18, he suddenly complained of lumbago and went into shock. His blood pressure dropped to 73/49 mmHg, and the hemoglobin level fell to 4.9 g/dL.Computed tomography revealed a huge retroperitoneal hematoma. Emergent lumbar artery embolization was performed on two consecutive days; however, the bleeding persisted, with subsequent development of abdominal compartment syndrome with impaired respiratory and cardiovascular function, and the patient died. Autopsy revealed a hematoma measuring 30×20×20 cm involving the psoas muscle and external iliac artery; the hematoma was covered with fibrous tissue instead of muscle. The psoas muscle is supplied by the internal iliac artery; however, a collapsed artery could not be confirmed in our patient. The closest major artery to the hematoma was located at the intersection of the psoas muscle and the external iliac artery. All arteries showed severe atherosclerosis. In patients with advanced chronic kidney disease, anticoagulant therapy should be administered carefully, and the etiology of retroperitoneal hematoma should be further investigated.

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Section: Discussionmentioning

confidence: 99%

Retroperitoneal Hematoma in a Patient with Advanced Chronic Kidney Disease Receiving Warfarin Therapy

et al. 2016

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“…The risk factors include hemostatic disorders, age, atheromatosis, vascular lesions from chronic arterial hypertension, and especially diabetes [3,11,12]. Furthermore, a genuine anticoagulant-induced immune microangiopathy has been reported to be a predisposing factor [11]. The occurrence of SMH is often associated with a microtrauma (closed glottis straining, isometric muscle contractions).…”

Section: Physiopathologymentioning

confidence: 99%

Spontaneous soft tissue hematomas

Dohan

Darnige

Sapoval

et al. 2015

Diagnostic and Interventional Imaging

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Spontaneous muscle hematomas are a common and serious complication of anticoagulant treatment. The incidence of this event has increased along with the rise in the number of patients receiving anticoagulants. Radiological management is both diagnostic and interventional. Computed tomography angiography (CTA) is the main tool for the detection of hemorrhage to obtain a positive, topographic diagnosis and determine the severity. Detection of an active leak of contrast material during the arterial or venous phase is an indication for the use of arterial embolization. In addition, the interventional radiological procedure can be planned with CTA. Arterial embolization of the pedicles that are the source of the bleeding is an effective technique. The rate of technical and clinical success is 90% and 86%, respectively.

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“…5 These highly vascular retroperitoneal structures share anatomic proximity to lumbar vertebrae, abdominal aorta, sigmoid colon and hip joints, making them targets for extension of adjacent infection. 6 Traditional nomenclature has characterized infections from distant sources of infection as 'primary IPAs' and infections from adjacent infectious source as 'secondary IPAs.…”

Section: Introductionmentioning

confidence: 99%