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A 53 year old man attended the accident and emergency department following a four hour history of severe left sided chest pain radiating through to his back and his left arm. ECG on admission showed 3 mm ST segment elevation in the inferior leads and he was thrombolysed using tenecteplase with subsequent electrocardiographic evidence of coronary reperfusion.
On the second day following admission he developed progressive lower right sided back pain radiating to his hip and groin. On examination there was bruising but no swelling around his groin. The right hip was held in flexion because of discomfort, movement was limited, and he reported parasthesia over the anterior thigh. The haemoglobin had dropped to 11.8 g/dl. Aspirin and post-thrombolysis heparin were stopped. An urgent computed tomographic scan confirmed an enlarged right psoas muscle which was approximately twice the diameter of the left (panel). This patient was seen by the surgical team and he was managed conservatively. Over the next three days the tenderness and parasthesia resolved and his haemoglobin remained stable.