gluteal hematoma ultrasound

gluteal hematoma ultrasound

Repetitive motions like squatting and lifting at work may cause inflammation in tissues surrounding the hip. mild aching when you walk and put pressure on the bruised buttock . Endovascular embolization was selected in all cases, either alone or with the evacuation of the hematoma, with complete procedural success. Ultrasound therapy is often used in sports medicine and physical therapy. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The posterior abdominal muscles consist of the iliacus, the psoas, and the erector spinae muscles, each of which receives their vascular supply from the posterior gluteal trunk via the lumbar and iliolumbar arteries. Superior Gluteal Artery Pseudoaneurysm - Applied Radiology Follow us on socials. Can Med Assoc J. Search Page 1/14: GLUTEAL HEMATOMA - ICD10Data.com Access free multiple choice questions on this topic. Take care. The injury to the gluteal artery is fairly uncommon, with superior gluteal artery being more commonly involved in injury [4]. Injection granuloma of the buttock. endobj Examining the hip may uncover pain with tenderness over the joint line or the greater trochanter. Rehab may include exercises to strengthen muscles and maintain range of motion to prevent future injury. More Cases from Taco Geertsma. Falls are a common cause of a gluteal or buttock contusion. Many patients choose deep tissue massage to relieve CLBP . Contrast material may be injected into a vein or the spinal fluid to enhance the scan. Hematoma | Physiotherapy News People may sometimes avoid accidental falls. We reasoned that applying pulsed US would produce nonthermal effects through an increase in acoustic microstreaming12 and an acceleration of fibrinolysis,18,19 which might accelerate the reabsorption of RSH. A low back MRI revealed a large herniated disc (his back hurt some, but most of his attention was on the butt pain). The upshot? At that point, the patient still had discomfort and the mass in her abdomen persisted. [1] [2] [3] In several articles, piriformis syndrome is defined as a peripheral neuritis of the branches of the sciatic nerve caused by an abnormal condition of the piriformis muscle . Deep tissue massage is a form of massage used to work with tissues in layers to relax, extend, and unlock the persisting, incorrect tensions, in the most effective and energy-efficient manner. The fluid collection had increased to 13 2 9 cm 3. Case report: Gluteal injection site granulomas: false positive finding on FDG-PET in patients with non-small cell lung cancer. Madhan Pandian MD., FIPM., CIPS., RMSK individuals who are claustrophobic, or suffer from anxiety or panic disorders Gluteal tendinopathy is a common cause of hip pain, especially in older women. De Simone et al. . ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Apply gel both inside and outside the glove. To observe the changes in condition, we had not prescribed the pain . Ambulatory Referral for image-guided biopsy (Radiology Performed) Providers can search for order code: REF325. Prosch H, Mirzaei S, Oschatz E et-al. The differential depends on whether or not the granuloma is calcified. Fall from height about 6 days ago. http://creativecommons.org/licenses/by-nc-nd/4.0/ Davis DD, Kane SM. endobj #G{c)wt;E}V# vtK@_.PC5Wkn{BR k2\&g#E6+ tGVxI6!qa#")sw%v,[V An injury can cause blood vessel walls . This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) 3), 24th (Fig. US Endovascular Stent and Renal Artery Complete w Doppler (C) - CPT Code 76775 & 93975 IMG 505. Capillary growth can be prominent. Check for errors and try again. Ultrasound Images & Clips Large false aneurysm in the gluteal muscle. Spontaneous muscle hematomas, in contrast, are mainly located in the abdominal waist area and have the potential to develop into life-threatening conditions.[1]. Ultrasound therapy was administered once a day, 5 times per week for 4 weeks, for a total of 20 sessions. Terms of Use. - Nearby vascular surgery. Spontaneous muscular hematomas similarly require an interdisciplinary approach to achieve the best outcomes. Use a probe cover if there is any concern for drainage from the lesion. <> A subcutaneous hematoma occurs when a ruptured blood vessel leaks blood into the surrounding fatty tissue. Learn about Regenexx procedures for hip conditions. A . , Bui P, Boccaccini H, et al. To figure out the cause and treat the problem often takes just someone who is willing to look for the problem. ), which permits others to distribute the work, provided that the article is not altered or used commercially. 1970;102 (6): 626-8. The following is the summary of "Point of care ultrasound needle guidance to assist diagnosis of acute gluteal compartment syndrome" published in the December 2022 issue of Emergency medicine by Puebla, et al. Organizing hematomas and thrombi have sonographic features similar to those of benign-looking soft tissue tumors. Ultrasound-guided aspiration of hematomas is a safe and effec-tive procedure. Pulsed US was used because this nonthermal option is thought to involves less risk of bleeding than thermal US (continuous wattage) mode. Palatucci V, Lombardi G, Lombardi L, Giglio F, Giordano F, Lombardi D. Spontaneous muscle haematomas: management of 10 cases. Monitoring of coagulation parameters took place every 6 to 8 hours, and the INR returned to normal 8 hours after intervention began. Inflammation of the hip, piriformis, iliotibial band, and the gluteus muscles are common running injuries. My doc did needle aspiration w/ ultrasonic guidance of a hematoma on pt.'s gastrocnemius. ULTRASOUND MUSCULOSKELETAL GUIDED INJECTION/ASPIRATION. This seemed to be tender so I attempted to remove the blood under ultrasound guidance. CT scan (computerized tomography) is a procedure that uses X-rays to scan and A gluteal contusion is a bruise to the muscle area. All rights reserved. However, after several visits to his family doctor produced no results other than a refusal to perform an MRI, he was frustrated. Several cases of infected hematomas have been reported.2,6,9. Symptoms include stiffness and pain around the hip joint. Acute changes in bowel or bladder function are associated with potential, Inspection or looking at the buttock area might reveal. , Aguayo JL, Flores B, et al. Disc herniation is also treated with epidural steroid injections. Unenhanced CT of abdominal and pelvic hemorrhage. Ultrasound therapy helps because micro vibrations enhance the absorption. FAQ; Legal; Newsletter. Michaels L, Poole RW. Berna Grimm MR, Vrahas MS, Thomas KA. the brain, legs, and lung, and lung infections or diseases like pneumonia diseases of the male reproductive organs. In order to prevent risk of new bleeding, we believe it is important that US therapy should not be initiated until the acute phase of the hematoma has passed. You can use Radiopaedia cases in a variety of ways to help you learn and teach. This outcome is a self-limiting condition that will typically decrease in size after a year.[14]. Gluteal tendinitis; Gluteal tendonitis. Symptoms of a broken bone include pain at the site of injury, swelling, and bruising around the area of injury. She had a tense left calf and a known history of alcoholic liver . This can be associated with gluteal tendinopathy (inflammation and damage of the gluteus tendon that attach the gluteal muscles to the greater trochanter). The thigh, hip, and pelvic region are the most commonly affected locations. On Day 11 post BMP, worsening pain and paresthesias prompted a Doppler ultrasound revealing a neous and deep fat of the gluteal region in-clude fibrous tumors, cellulitis (Fig. Figure 1 from Ultrasound use of post-traumatic gluteal haematoma in a This cavity is surrounded by fibrous tissue and reactive inflammatory cells (lymphocytes, foamy histiocytes, and giant cells). You are not required to obtain permission to distribute this article, provided that you credit the author and journal. If the gluteal injury is due to overuse, or an abnormal gait (pattern of walking), physical therapy may be considered to prevent further injury and inflammation. This study was supported by grants (No. Gluteal Tendinopathy: Symptoms, Causes & Treatment - Cleveland Clinic Spontaneous muscular hematomas are classically associated with anticoagulation treatment and typically occur in three anatomic regions: The anterior abdominal wall consists of the rectus abdominis, the external oblique, the internal oblique, and the transverse abdominis. Google Scholar [2] J.M . Severe hematoma of the buttock following a gluteal compartment syndrome due to a vascular injury. N Is it possible to prevent a gluteal injury? Advances in ultrasound technology, including higher-frequency transducers, allow diagnosis of many types of musculoskeletal abnormalities, in many cases with an accuracy similar to that of MRI [1-4].Ultrasound has additional advantages compared with MRI, such as lower cost and . A Prep: NPO 6 hours including no smoking and no gum, however, may take medications with small . The buttock is a common site of pathology and ultrasound and is often the first-line imaging modality to examine soft tissue lesions of the buttock region. | Check a doctor's response to similar questions: Physical therapy exercises can help, although some people need other interventions. May 2012 | Ultrasound Cases <>>> We instructed the patient to rest and avoid physical effort and to return to the hospital if signs of abdominal pain appeared. Once familiar with the entity they rarely pose any diagnostic confusion. Isn't this code for a skin hematoma? This review describes the ultrasound technique used, the relevant ultrasound anatomy, and the sonographic appearances of common and uncommon pathological conditions found in the buttock region. Both terms are used interchangeably all over the world. Magnetic resonance imaging (MRI) revealed a significant hematoma in the gluteus maximus fibers (Figure 0001) and angiography revealed bleeding from a small artery (Figure 0002). Reference article, Radiopaedia.org (Accessed on 04 Mar 2023) https://doi.org/10.53347/rID-1393, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1393,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/gluteal-injection-site-granuloma/questions/364?lang=us"}. [Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.]. 554-610. Physical examination will focus on the low back, buttock, and hips. EH5v{gc%?I\ZY n T2O^*/^mIWmv:%eU^SNLbfr}Sm[.S-}Oc~~ahhqs~[Yu87?o3L&_#RZFIL:Q-#cX:Di;(Ld/f,e^gelm d\[zsjO{4];IP5]Jg, N=8%[& 3$1_RKny1#o];iB+%H~eOZ*H*_3|}5s1odx e1QBoqVM':l4 @6a&Xhf3H8'=AQY0@$>Mw1KMDK%BLLuD K"?V_CgW;?f$:/s&@ Hn~a'ZkY8oVoD:g}:KE$3zCkZ?UernnBDi$#n@hi,&p"O ]j-xbHXM&g IMG2882. The Ultrasound CPT Codes and Reimbursement lists below are completely searchable and sortable by column to make it easier . Should the gluteal injury be due to a direct blow or fall, resulting in a contusion, treatment aims to decrease the inflammation in the area. Ultrasound is usually not definitive for diagnostic imaging purposes in evaluating cystic neck masses except for thyroid masses. , Baker KG. We believe that conservative management of RSH, especially in cases of large RSH, requires close coordination of the surgeon, radiologist, hematologist, and physical therapist. Donaldson J, Knowles CH, Clark SK, Renfrew I, Lobo MD. Gann Axial view scanning at proximal, Madhan Pandian MD., FIPM., CIPS., RMSK LinkedIn: Assessment and Treatment of Carpal Tunnel Syndrome is never complete Patients who develop a spontaneous muscular hematoma should be evaluated by a healthcare professional who can carefully weigh the risks and benefits of all treatment options. , Onundarson PT, Carstensen EL, et al. A rubber donut may be used to decrease the pain of sitting on a swollen buttock. Our doctors define difficult medical language in easy-to-understand explanations of over 19,000 medical terms. A CT scan is a low-risk procedure. The goal of gluteal injury treatment is to return patients to their normal level of function. Finally, in this region, one should also assess the possibility of a strangulated hernia, torsion of an ovarian cyst, obstruction or perforation of the intestine, abdominal neoplasm, or appendicitis.[11][12][13]. Following a bout of coughing, she experienced sudden abdominal pain. US BIOPSY THYROID, BILATERAL. Gluteal injection site granuloma | Radiology Reference Article Ultrasound Therapy in Rectus Sheath Hematoma - Oxford Academic While he had a massive collection of blood from his fall that nobody found until an ultrasound revealed the issue, that turned out to be window dressing. It has been widely used for relieve pain and promote functional recovery . StatPearls Publishing, Treasure Island (FL). This leads to pain, making it difficult to sit on the buttocks, or stand and/or walk normally because of the decreased range of motion of the hip. Overuse injuries may take longer to heal, but the goal is to return patients to their normal level of function. A comprehensive secondary examination can be an effective way to identify less obvious injuries, and radiography is a good initial screening tool. IMG6209. If you have questions or comments about this blog post, please email us at [emailprotected]. Based on the CT classification described previously,2 the hematoma was classified as type III. Myositis ossificans is a reactive process within the muscle secondary to traumatic muscular hematomas characterized by a proliferation of fibroblasts, cartilage, and bone. Epidural injections are also used to treat nerve compression in the neck (cervical radiculopathy).The procedure is quick and simple. What is a gluteal injury? Muscular hematomas are a common source of extravasated blood from within a muscle group, most commonly occurring in the abdominal waist. health & living health center/exercise & fitness a-z list/gluteal injury article. Resolution of the abdominal mass was rapid. Traumatic muscle hematomas, while painful to the patient, are manageable with conservative rest and non-narcotic pain medication. Waters-Banker C Dupont-Versteegden EE Kitzman PH. Nonetheless, practitioners must be cautious to avoid overprescribing anticoagulants, which can occur in up to 33% of such cases. There are different types of fractures, such as: A bruise, or contusion, is caused when blood vessels are damaged or broken as the result of a blow to the skin. The patient underwent US imaging at the end of US therapy and also after a 2-week follow-up. . A CT-angiogram may be warranted to evaluate better the hematoma and the source and from which vascular structure it originates. In contrast, spontaneous muscular hematomas are often the site of active bleeding. Ice, elevation, and rest may be helpful. Ultrasound examination identified a hematoma within the muscle fibers of left gluteal maximus. Devcic-Kuhar PDF Low Impact Injury Leading To Gluteus Maximus Hematoma In A Nonagenarian See additional information. You may find that if the hematoma is further away from the skin you may only feel a "fatty" or mobile lump without the bruise or only a light discoloration. or emphysema. He underwent the Regenexx-PL disc procedure for his irritated low back nerve and I saw him today, without his cane! He underwent the Regenexx-PL disc procedure for his irritated low . The exam was notable for a large hypoechoic fluid collection deep to the subcutaneous tissue and superior to the gluteal musculature (Figures 1 and 2). Angiography showing a ruptured superficial branch of the superior gluteal artery (arrow). The procedure started with intravenous unfractionated heparin in prophylactic doses of 100 IU/kg/d and continued with subcutaneous low-molecular-weight heparin (enoxaparin) in doses of 2,850 IU anticoagulation factor Xa every 12 hours. Created with. Subsequent endovascular embolization treatment which used the small coil to stop bleeding of the tiny artery via femoral artery vessel was done and the pain was relieved gradually (Figure 0003). Zissin R, Ellis M, Gayer G. The CT findings of abdominal anticoagulant-related hematomas. Physical therapy may also be helpful in treating tendinopathies and other inflammation of the gluteus muscles not due to trauma. Transluminal coil embolization of an inferior gluteal artery aneurysm by ultrasound-guided direct puncture of the target vessel. Providers listed on the Regenexx website are for informational purposes only and are not a recommendation from Regenexx for a specific provider or a guarantee of the outcome of any treatment you receive. What are the types of gluteal injuries? Four hours later, the pain had gradually increased that the VAS reached nine meanwhile there was an obvious swelling appeared in the central of left buttock. The real cause of his severe butt pain and inability to walk was a pinched nerve in his low back. Hematoma is generally defined as a collection of blood outside of blood vessels. Some of these patients have injured muscles, tendons, nerves, or ligaments-but all too often they get blown off. "Spontaneous" hematoma of the rectus abdominis muscle: critical review of 50 cases with emphasis on early diagnosis and treatment. Administration of vitamin K1 and fresh frozen plasma was suspended 20 hours after admission, when laboratory data indicated that bleeding had ceased. One source,"Therapeutic Modalities for Physical Therapists", by William E. Prentice, pg. Infection of the musculoskeletal system can be associated with high mortality and morbidity if not promptly and accurately diagnosed. Dohan A, Darnige L, Sapoval M, Pellerin O. Spontaneous soft tissue hematomas. On physical examination, a tender mass (12 8 cm) of soft consistency over the infraumbilical right abdomen was detected. Nonthermal effects may include cavitation and acoustic microstreaming.12 A combination of thermal and nonthermal effects may result in stimulation of fibroblast activity, increased protein synthesis, increased blood flow, and tissue regeneration.12 Nonetheless, the effectiveness of US remains questionable.1216. Ultrasound Exam Ordering Guide | UCSF Radiology - Often history of trauma. MRI reveals an encapsulated expansive two-lobes mass located in the right gluteal region. van der Windt Conditions Where Ultrasound Therapy Should Not Be Used - Verywell Health He was the head of the ultrasound department for many years. His story might be helpful to other patients with buttock pain after falling, as his case was one of a bright, shiny object which looked like the cause of his pain and a more subtle problem which turned out to be the cause. 4. The purpose of this case report is to describe the intervention, including the use of US, in the management of a large rectus sheath hematoma (RSH) in a patient receiving anticoagulant therapy. View. Similar to that found in hemorrhagic ovarian cysts. Y Because of bleeding that may be deep and not immediately apparent on the surface of the skin, inflammation may occur causing the buttock to feel swollen, warm, and become slightly red. This risk is increased in the elderly and pts on anticoagulation. The internal iliac artery supplies this complex of muscles via the superior and inferior gluteal muscles. PAIN MED. Fu Sun. Disc herniation is usually the cause of sciatica. Blood tests are not usually done, except for patients who take. {"url":"/signup-modal-props.json?lang=us"}, Gaillard F, Bell D, Sharma R, et al. Therefore, all providers involved in the care of this patient must carefully weigh the risks and benefits of any intervention, with consideration given to all medical comorbidities. IH'm_Cx\M~D dFI4GQ': ( Ws283b`m?hf#LN0 Lf4;?a~w?,9JWW7xSO2@#Zhy}iNZ''7fG_;X>od\L56t{{p27eN8I7=5s b9thSCi$c=p%4= Bz~We[PaesAkvz?-$b7iGni%!P8WX_ _xH>4sge.2!c73zzjb!g<9.Al~([k$[!l1)e7"q)MV7|;h)#r)CYjK%oDhtEpBp}84KIN48XPG3OoNW(q'?7S>N7NAM19{Z>KPnk6-_ythwpk':lkU=l|!VUWi.-HE9ceu!^T5fO%yU]A7J4,Mb@]zPQ Oxford University Press is a department of the University of Oxford. The provisional diagnosis was injury of the SGA with hematoma and pressure on the sciatic nerve. 2011 Oct;30(10):1431-6. doi: 10.7863/jum.2011.30.10.1431. Check for errors and try again. Ultrasonographic Examination of the Adult Hip - ScienceDirect WL Treatment is often supportive with ice, elevation, and rest. Pain in the Butt: Spectrum of Gluteal Region Abnormalities in Children These are characteristic features of hematoma on ultrasound. At 3 and 6 months after cessation of US therapy, the patient was asymptomatic, and her physical condition was normal in follow-up examinations carried out in our hospital by the surgeon involved in the case. , Chen X, Francis CW, et al. The function of the gluteus medius muscle is to work with other muscles on the side of your hip to help pull your thigh out to the side in a motion called hip abduction. Ultrasound of the Thigh: Focal, Compartmental, or Comprehensive Qiling Yuan. <> Treating a Hematoma in the Buttocks. Need cpt code for aspiration of hematoma - AAPC 2 0 obj Symptoms and signs include pain and swelling. Fusato The patient's hemoglobin level was 8.7 g/dL (normal range=1216 g/dL), the hematocrit level was 31.2% (normal range=36%-47%), the platelet count was 300,000/L (normal range=125,000450,000/L), and the leukocyte count was 21,400/mL (normal range=4,000/mL11,000/mL). [9], Arterial embolization is sometimes proposed as a treatment option for the management of spontaneous muscular hemorrhages and has the advantage of being less invasive than surgical evacuation while maintaining a clinical success rate of 57to 69%. C. Martinoli (Eds. Dr Berna-Serna provided writing, and Dr Berna-Serna and Mr Berna-Mestre provided data collection. In: StatPearls [Internet]. Large Buttocks Hematoma Caused by Deep Tissue Massage Therapy The CT findings following intervention showed a slight asymmetry of the rectus abdominis muscle (Figure, bottom image). Traumatic hematomas are generally managed conservatively, especially in patients who are not currently receiving treatment with anticoagulants. . Arterial elasticity is negatively correlated with age and high blood pressure can also cause hardening of arterioles . Other muscles, nerves, and bursae in the gluteal region that may cause, Hip rotator muscles: Piriformis, obturator, quadratus, and gemellus muscles, Most commonly, gluteal injuries are due to local. Titone C, Lipsius M, Krakauer JS. Muscular Hematoma - StatPearls - NCBI Bookshelf The Endovascular Management of an Iatrogenic Superior Gluteal Artery - Nearby surgery. Arteriole flexibility had decreased significantly in our case, making the arterioles prone to rupture with external forces and when subjected to aggressive massage therapy such as deep tissue massage therapy, the blood vessel ruptured. History is the first important step in helping the health care provider make a diagnosis. Both CT and MRI are painless, however, MRI can be more bothersome to some A CT-angiogram has a higher sensitivity than arteriography, especially in the abdomen, with a sensitivity of 80% and specificity of 67%.[7][8]. This is especially true for elderly patients and those who may have impaired balance. Falls or direct blows to the buttock can cause bleeding, inflammation, and swelling. Computed tomographic (CT) scan showing hematoma (arrows, top image); CT scan showing slight asymmetry of the rectus muscle (arrow, bottom image). The treatment area was determined by reference to the ultrasonographic findings, and it was limited to an area between 40 and 60 cm2. Andexanet alfa is a drug approved for use to reverse apixaban and rivaroxaban in cases of serious hemorrhage, typically reserved for pts undergoing operative intervention due to cost. The muscles of the buttocks are the gluteus maximus, medius, and minimus, as well as the piriformis and the short external rotators. The mechanic of Massage therapy include: local vasodilation and increase blood and lymph circulation to improve the nutritional status of local organs; deep tissue blood flow to the surface or reduced blood flow locally to reduce congestion; regulation of muscle function, increased muscle flexibility, relief of muscle tension, and promotion of metabolite excretion; regulation of nerve function: stimulating, inhibiting, or fatiguing the nerves . 86 clinic locations offering non-surgical Regenexx solutions for musculoskeletal pain. Perhaps hes making up for all of those years in fatigues. The patient had a favorable outcome following conservative management and pulsed US. A Comparison of Perceived and Observed Practice Behaviors, Rehabilitation for COVID-19 Lung Transplant, A Systematic Appraisal of Conflicts of Interest and Researcher Allegiance in Clinical Studies of Dry Needling for Musculoskeletal Pain Disorders, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 American Physical Therapy Association. Buttock pain after running can be from muscle strain. Rectus sheath hematoma (RSH) is an uncommon and often misdiagnosed condition.1 The most frequent location is infraumbilical.2,3 The causes of RSH described in the literature include anticoagulant therapy, hematological disorders, trauma, physical exercise, coughing, sneezing, pregnancy, and hypertension.110 The most frequent predisposing factor is anticoagulant therapy, and the most important precipitating factor is coughing.2,10 Rectus sheath hematoma can be suspected in women above 60 years of age who have the clinical triad of acute abdominal pain, an abdominal mass, and anemic syndrome. Beiner JM, Jokl P. Muscle contusion injuries: current treatment options. In uncertain situations, imaging is frequently performed to . see full revision history and disclosures. Finally, in this region, one should also assess the possibility of a strangulated hernia, torsion of an ovarian cyst, obstruction or perforation of the intestine, abdominal neoplasm, or appendicitis. However, while this was the low hanging fruit, he also had evidence on exam of sciatica (pinched S1 nerve in his back). Ultrasound (and ultrasonography) is imaging of the body used in the medical diagnosis and screening of diseases and conditions such as: Facts you should know about a gluteal injury. The report describes the patient examination, management, intervention, and outcomes. Hematoma: Types, Treatment, Symptoms, Pictures & Causes - RxList Unable to process the form. Visual analogue scale (VAS) of the pain is 6 (the boundary of scale is 010, rating them from no pain at all to the worst pain imaginable). An injury to a ligament is called a sprain, and an injury to muscle or tendon is called a strain. ; During pregnancy: The effect of therapeutic ultrasound on a . A pelvic CT with contrast revealed a 3.42.6 cm gluteal hematoma and a pseudoaneurysm of the right gluteal artery in the right piri-formis muscle immediately adjacent to the right PSIS (Figure 1A). These muscles obtain their vascular supply from the inferior epigastric arteries and the circumflex iliac arteries. MRI T2-weighted magnetic resonance images showing irregular bleeding in the gluteal muscle (arrow).

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