The shadow of the psoas major disappears

Introduction X-ray examination of retroperitoneal hematoma, from the spinal or pelvic fractures, the disappearance of the psoas muscle shadow and renal shadow abnormalities, suggesting the possibility of retroperitoneal hematoma. The most common cause is pelvic and spinal fractures, accounting for about 2/3; followed by rupture of the retroperitoneal organs (kidney, bladder, duodenum, and pancreas) and major vascular and soft tissue injuries. Abdominal, spinal and pelvic trauma with abdominal pain, bloating and low back pain, hemorrhagic shock, abdominal muscle tension and rebound tenderness, weakened or disappeared bowel sounds should all consider the possibility of retroperitoneal hematoma.

Cause

The cause of the disappearance of the psoas muscle shadow:

The most common cause is pelvic and spinal fractures, accounting for about 2/3; followed by rupture of the retroperitoneal organs (kidney, bladder, duodenum, and pancreas) and major vascular and soft tissue injuries.

an examination

Related inspection

Abdominal vascular ultrasound laparoscopic

Examination and diagnosis of the disappearance of the psoas muscle shadow:

Abdominal, spinal and pelvic trauma with abdominal pain, bloating and low back pain, hemorrhagic shock, abdominal muscle tension and rebound tenderness, weakened or disappeared bowel sounds should all consider the possibility of retroperitoneal hematoma. X-ray examination, from the spine or pelvic fracture, the disappearance of the psoas muscle shadow and kidney shadow abnormalities, suggesting the possibility of retroperitoneal hematoma. B-mode ultrasound and CT examinations often provide a reliable basis for diagnosis.

Retroperitoneal hematoma is also often associated with peritoneal irritation (intestinal paralysis, tenderness and rebound tenderness, muscle tension, etc.), which makes it difficult to determine the presence or absence of intra-abdominal injuries. A simple retroperitoneal hematoma without large blood vessels or important organ injury, the peritoneal irritation sign appears later and mild, and it can be effective after anti-shock treatment. Diagnostic abdominal puncture can often be differentiated from intra-abdominal hemorrhage, but the puncture should not be too deep, so as not to penetrate into the retroperitoneal hematoma, so that the intra-abdominal hemorrhage is mistaken for laparotomy. If the diagnosis is not certain, close observation is absolutely necessary.

The retroperitoneal hematoma lacks characteristic clinical manifestations, and there is a large difference in the extent of hemorrhage and hematoma. Abdominal pain is the most common symptom. Some patients have abdominal distension and low back pain, and 1/3 of patients with hemorrhagic shock. A large hematoma or accompanied by infiltration into the peritoneal cavity may have abdominal muscle tension and rebound tenderness, and the bowel sounds may be weakened or disappeared.

More than 90% of retroperitoneal hematoma caused by abdominal aorta (abdominal aorta and inferior vena cava) injury is caused by penetrating injury. Due to rapid and massive bleeding, most patients died on the scene, and the death rate after delivery to the hospital was 70%. Progressive bloating and shock suggest that the diagnosis should be performed immediately after active anti-shock, laparotomy to control bleeding.

Differential diagnosis

Symptoms of flaccid paralysis disappeared easily:

Lumbar muscle tendon: chronic lumbar muscle strain, common clinical disease, frequently-occurring disease, more pathogenic factors, the main symptoms are waist pain, increased fatigue during the day, can be relieved after rest, accumulated over time, can make muscle fiber degeneration, even a small amount of tear Forming scars or fibrous cords or adhesions, leaving long-term chronic low back pain. The treatment is mainly based on non-surgical treatment. If various non-surgical treatments are ineffective, surgery can be performed.

Lumbar muscle swelling: the psoas muscle, a long fusiform muscle, from both sides of the lumbar vertebrae, together with the Iliacus muscle end point on the lower trochanter of the femur (Lesser trochanter), collectively known as "squat muscle." The swelling of the psoas muscle is caused by inflammation. Pain: Mostly mild and dull, rest is light, tired is heavy, coughing, sneezing or holding things, but nighttime patients can sleep better, which is different from malignant tumors. The patient complained that the pain site was sometimes inconsistent with the lesion, and patients with thoracolumbar lesions often complained of lumbosacral pain. If you do not check carefully, or only take the X-ray film of the lumbosacral region, it will often miss the diagnosis. If the kyphosis is severe, it can cause strain on the lower back and cause pain. If the lesion compresses the spinal cord and nerve roots, the pain can be quite intense and radiate along the nerve roots.

Psoas muscle abscess: refers to the inflammation of the waist or abdominal cavity leading to pus and parenchyma infection, forming an abscess.

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