Lumbar Artery Pseudoaneurysm Presenting as Psoas Muscle Hematoma Following Vertebral Compression Fracture in an Elderly Patient: A Case Report

Lumbar artery pseudoaneurysm is a rare vascular complication of vertebral compression fractures that can lead to life-threatening retroperitoneal hemorrhage. We report the case of an 84-year-old man with a history of cerebral infarction who was on clopidogrel and presented with acute back pain after a fall. Initial imaging revealed L1 and L2 compression fractures and left psoas hematoma without active bleeding. The patient was managed conservatively. However, follow-up computed tomography demonstrated the enlargement of the hematoma with the development of a pseudoaneurysm arising from the left third lumbar artery. Endovascular embolization was successfully performed using gel foam and coils. Post-procedure imaging confirmed the stabilization of the hematoma without recurrent bleeding, and the patient was discharged uneventfully. Lumbar artery pseudoaneurysms should be considered in older adult patients with persistent or progressive psoas hematomas following vertebral fractures, especially in those on antithrombotic therapy. Endovascular embolization is a safe and effective treatment modality.