Other Studies:
X-rays were initially obtained for hip pain to rule down the possibility of a stress fracture. X-rays were unremarkable. As her hip pain became recalcitrant despite physical therapy and rest from softball, magnetic resonance imaging (MRI) was ordered of her hip.
<br>
<br>Hip MRI discovered a large, heterogeneous dumbbell-shaped mass identified at the myotendinous junction of the iliopsoas muscle. Large hematoma associated with grade 2 iliopsoas tear identified. Iliopsoas tendon found to be intact. <a href="CaseStudyImages/CS1SwingFromTheHipAn-976.jpg" title="Case Photo #1" data-lity><b>Case Photo #1</b></a> <a href="CaseStudyImages/CS2CS1SwingFromTheHi-976.jpg" title="Case Photo #2" data-lity><b>Case Photo #2</b></a>
<br>
<br>Despite further physical therapy, ibuprofen, and cyclobenzaprine, the pain persisted at one-month follow-up. Further MRI was obtained which demonstrated slight enlargement of hematoma. Complete blood count and coagulation studies were ordered.
<br>
<br>Complete blood count and coagulation studies were unremarkable.
Consultations:
Orthopedic oncology was consulted for evaluation of hematoma versus potential mass. Interventional radiology was then consulted for drain placement of hematoma along with tissue plasminogen activator (tPA).
<br>
<br>Patient became syncopal, requiring transfusion of packed red blood cells.
<br>
<br>Additional angiography identified left medial profundal femoris artery pseudoaneurysm. <a href="CaseStudyImages/CS3CS2CS1SwingFromTh-976.jpg" title="Case Photo #3" data-lity><b>Case Photo #3</b></a>
Click here to continue. Challenge yourself by writing down a revised, working diagnosis before moving to the next slide.