1000 Section - Psoas hematoma after lumbar plexus block in low back pain

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

wl

won hyung lee, MD

professor, Doctor
Eulji Medical Center, Eulji University
Daejeon, Taejon-jikhalsi, Republic of Korea

Corresponding Author/Autor a quien dirigir la corr(s)

HK

Han Young KIm, MD

professor, Doctor
Eulji Medical Center, Eulji University
Daejeon, Taejon-jikhalsi, Republic of Korea

Case Diagnosis: A 45-year-old woman presented with low back and gluteal pain after a traffic accident one month earlier. Lumbar radiographs demonstrated degenerative spondylolisthesis and a herniated intervertebral disc at L5–S1. Straight-leg raise testing and sensory and motor examinations of the lower extremities were within normal limits.

Case Description: She underwent bilateral lumbar plexus blocks via a posterior approach under C-arm fluoroscopic guidance. Ten milliliters of a solution containing 0.125% ropivacaine and 10 mg triamcinolone was injected on each side. Immediately after the procedure she experienced transient weakness of left hip flexion and decreased sensation in the L2 dermatome; these symptoms resolved within 2.5 hours. On the following day her low back pain had improved, but she developed left-sided abdominal pain and localized tenderness. General surgery and gynecology evaluations were unremarkable.

Discussions:

Follow-up lumbar MRI revealed a left-sided lumbar plexus hematoma with multiple scattered clots and diffuse serous fluid (Figure). Her symptoms resolved with conservative management—nonsteroidal anti-inflammatory drugs and rest—over two weeks.

Conclusions:

This case highlights an uncommon complication of lumbar plexus block despite the use of image guidance. Clinicians should be aware of the potential for hematoma formation even when the procedure is performed under C-arm guidance with contrast.