Psoas hematoma due to segmental vessel injury leads to paresis following CT-guided biopsy of lumbar vertebrae: A case report

BACKGROUND: Percutaneous bone biopsy is the first-line procedure for obtaining a tissue diagnosis to confirm focal, diffuse vertebral, and/or paravertebral metastatic lesions. Percutaneous bone biopsy to evaluate metastatic disease can be performed under fluoroscopy, ultrasonography, magnetic resonance (MR) imaging, and computed tomography (CT). Notably, CT-scans best direct and demonstrate the needle position for these procedures, decreasing the risk of injury to critical adjacent structures (e.g. major vessels, nerve roots). Hemorrhagic complication to lumbar segmental arteries following needle biopsy are uncommon; only a few cases have been reported. Although percutaneous bone biopsy is typically safe when performed utilizing computed tomography (CT) guidance, here we encountered a 60-year-old-female who developed a L4 lumbar segmental artery psoas hematoma following this procedure requiring emergent embolization. CASE DESCRIPTION: A 60-year-old female, with a history of breast cancer, underwent a CT-guided core needle biopsy of an L4 lytic lesion (e.g., likely a metastasis). This acutely resulted in the onset of radicular leg pain and weakness. When the postprocedural CT scan demonstrated a large psoas hematoma attributed to laceration of the left posterior L4 segmental artery, the patient required emergent embolization. Following this procedure, she exhibited a fully neurological recovery. CONCLUSION: Following a CT-guided L4 vertebral biopsy to document metastatic breast carcinoma, a 60-year-old patient developed an immediate postprocedure CT-documented psoas hematoma due to laceration of the left posterior L4 segmental artery. Following emergent embolization, the patient recovered full neurological function.