wjnu
World Journal of Nephrology and Urology, ISSN 1927-1239 print, 1927-1247 online, Open Access
Article copyright, the authors; Journal compilation copyright, the World J Nephrol Urol and Elmer Press Inc
Journal website http://www.wjnu.org
 
Case Report
Volume 3, Number 3, September 2014, pages 137-139
                                                                                

Hematoma of the Psoas Muscle in Prostatic Cancer Patient: A Case Report


Ziyad Almushaytia, c
, Abduljaleel Poovathumkadavib


a
Medical Imaging Department, College of Medicine, Qassim University, Buraydah, Saudi Arabia

bMedical Imaging Department, King Fahd Specialist Hospital, Dammam, Saudi Arabia

cCorresponding Author: Ziyad Almushayti, Qassim University, Buraydah, Saudi Arabia

 

Manuscript accepted for publication August 12, 2014

Short title: Psoas Muscle Hematoma

doi: http://dx.doi.org/10.14740/wjnu179e



Abstract

 

We report a case of a 64-year-old male with prostate cancer and coagulation disorder who presented with abdominal distension. He underwent abdomen and pelvis ultrasound for assessment of ascites, which showed localized fluid collections identified at the left and right iliac fossa. After that, non-enhanced abdomen and pelvis CT scan was performed and showed heterogeneous organized collections identified along the psoas muscles bilaterally, causing focal contour bulge representing hematoma.

 

Keywords: Prostate cancer with coagulation disorder; Psoas muscle hematoma

 


Introduction

 

Prostate cancer is the second most common urological malignancy to be associated with paraneoplastic syndromes after renal cell carcinoma and one of these syndromes is a hemorrhagic disorder. We report a case of a 64-year-old male with prostate cancer and coagulation disorder in form of bilateral psoas muscles hematoma.

 


Case Report

 

A 64-year-old man with prostate cancer, bone metastasis and coagulation disorder presented with abdominal distension. He underwent abdomen and pelvis ultrasound for assessment of ascitis, which showed localized fluid collections identified at the left iliac fossa with volume approximately 74 mL and right iliac fossa with volume approximately 48 mL (Fig. 1, 2).

 

Figure 1. A localized fluid collection indentified at left iliac fossa with volume approximately 74 mL. 

 

Figure 2. A localized fluid collection indentified at right iliac fossa with volume approximately 48 mL.

 


After that,
non-enhanced abdomen and pelvis CT scan was performed and showed heterogeneous organized collections identified along the right and left psoas muscles causing focal contour bulge representing hematoma, with the volume reaching approximately up to 100 mL on the right side and 150 mL on the left side. There is minimal fat stranding surrounding the psoas muscles, more significant on the left side (Fig. 3, 4).

 

 

Figure 3. There are heterogeneous organized collections identified along the right and left psoas muscles causing focal contour bulge representing hematoma. 

 

Figure 4. There are heterogeneous organized collections identified along the right and left psoas muscles causing focal contour bulge representing hematoma, minimal fat stranding surrounding the psoas muscles, more significant on the left side.

 

 

Discussion

 

Prostate cancer is the second most common urological malignancy to be associated with paraneoplastic syndromes after renal cell carcinoma and one of these syndromes is a hemorrhagic disorder. These syndromes tend to occur in the setting of late stage and aggressive tumors with poor overall outcomes. Paraneoplastic syndromes represent a constellation of conditions that are caused by the presence of malignancy, but not attributable to direct tumor invasion or compression. Up to 8% of patients with cancer are estimated to be affected by paraneoplastic syndromes [1].

 

Recognition of these syndromes is clinically important as it might lead to the detection of underlying malignancy and impact on the treatment options available. Over 70% of cases document the syndrome as the initial clinical manifestation of prostate cancer, while in just under 20% the syndrome was an initial sign of disease progression to the castrate-resistant state. The causes of paraneoplastic syndromes in prostate cancer are incompletely understood [1].

 

The spectrum of hematological disorders associated with prostatic malignancy ranges from acute bleeding diathesis to thrombosis and embolic events. Disseminated intravascular coagulation (DIC), however, is the disorder most commonly observed in patients with prostate cancer. DIC can be chronic or acute in nature and is characterized by the increased production of fibrin, increased fibrinolysis and unchecked coagulation throughout the systemic circulation [1].

 

Thrombin activation can cause microthrombosis at the small-vessel to mid-vessel level [1]. Over time, the clotting proteins in blood are “used up”. When this happens, it is a higher risk for serious bleeding. Also, consumption of coagulation factors and aggressive fibrinolysis can cause acute bleeding. It has been suggested that subclinical DIC is relatively common in patients with metastatic prostate cancer [1]. So, hematoma of the psoas was caused by disseminated intravascular coagulation arising from multiple bony metastases of a prostatic cancer [2].

 

Clotting profiles should be monitored closely in patients with prostate cancer and paraneoplastic DIC, as abnormalities might need to be corrected before or after biopsy [1].

 

Treatment of hematological paraneoplastic disorders is two-fold: management of the underlying prostate cancer and supportive therapy for the coagulation disorder [1].

 

To conclude, hematoma of the psoas muscle in prostate cancer patient is generally secondary to a coagulation disorder. Treatment is two-fold: management of the underlying prostate cancer and supportive therapy for the coagulation disorder.
 

 
 
References
 

1.

Hong MK, Kong J, Namdarian B, Longano A. Paraneoplastic syndromes in prostate cancer. Medscape Radiology. 2011.

2.

Valero Puerta JA, Jimenez Gonzalo FJ, Sanchez Gonzalez M, Valpuesta Fernandez I, Alvarez Santalo R. [Hematoma of the psoas, a hemorrhagic complication of prostatic cancer]. Arch Esp Urol. 1998;51(5):491-493.
pubmed

 


This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


World Journal of Nephrology and Urology is published by Elmer Press Inc.

 
Home     |     Log In     |      About     |      Search     |      Current     |      Archives     |      Submit      |     Subscribe


 

     

Aims and Scope

Current Issues

Conflict of Interest

About Publisher

Editorial Board

Archives

Copyright

Company Profile

Editorial Office

Misconduct and Retraction

Permissions

Company Registration

Contact Us

Abstracting and Indexing

ICMJE

Ownership

Instructions to Authors

Access

Declaration of Helsinki

Contact Publisher

Submission Checklist

Reprints

Terms of Use

Company Address

Submit a Manuscript

Open Access Policy

Privacy Policy

Browse Journals

Publishing Fee

Publishing Policy

Disclaimer

Recent Highlights

Peer-Review Process

Publishing Quality

Code of Ethics

Advertising Policy

Manuscript Tracking

Advanced Search

For Librarians

Careers

Publishing Process

Publication Frequency

For Reviewers

Propose a New Journal

       
       

World Journal of Nephrology and Urology, quarterly, ISSN 1927-1239 (print), 1927-1247 (online), published by Elmer Press Inc.     
The content of this site is intended for health care professionals.
This is an open-access journal distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License, which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.wjnu.org   editorial contact: editor@wjnu.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada
© Elmer Press Inc. All Rights Reserved.

DECLARATION: THIS JOURNAL SITE OUTLOOK IS DESIGNED BY THE PUBLISHER AND COPYRIGHT PROTECTED. DO NOT COPY!