Medical Imaging Analysis Report

I. Imaging Findings

From the provided abdominal CT images, a large soft-tissue density shadow is observed in the right psoas major region and the adjacent retroperitoneal space. On some slices, it appears as a round or oval lesion with higher density compared to the surrounding normal tissue. The margins are not well-defined, and nearby structures (kidneys, lumbar vertebrae, etc.) are displaced, but there is no obvious evidence of organ rupture. No clear disruption of bony continuity or vertebral fractures is seen. The kidneys and adjacent structures appear largely normal, though the presence of fluid or blood within and around the psoas muscle cannot be excluded. Overall, the findings suggest a suspected retroperitoneal hematoma.

II. Possible Diagnoses

1. Retroperitoneal Hematoma:
   • The patient has a history of lower back trauma and local pain; imaging shows a mass in the retroperitoneal space, which is consistent with hemorrhage due to trauma or vascular injury.
   • The retroperitoneal space contains abundant loose connective tissue and fat, allowing blood to accumulate easily. Clinically, this often presents with back pain, decreased hemoglobin, and possible signs of shock.
2. Psoas Abscess:
   • A low-density lesion can develop in the psoas muscle. However, it is typically associated with signs of infection, such as fever, elevated white blood cell count, and significantly increased C-reactive protein.
   • This condition often appears in tuberculosis or other bacterial infections, sometimes without a clear history of trauma. Radiologically, it commonly shows a relatively homogeneous low density and may be accompanied by irregular thickening of the muscle fascia.
3. Retroperitoneal Tumor (e.g., Lymphoma or Soft Tissue Tumor):
   • In some cases, a tumor may present as a retroperitoneal mass; however, growth tends to be slower, and the density or signal characteristics are not typically fluid-like or mixed-density. Significant blood loss over a short period is uncommon with such tumors.
   • Clinical correlation is needed to determine if there are malignant symptoms, and further investigations such as contrast-enhanced imaging or biopsy may be required for differential diagnosis.

III. Final Diagnosis

Considering that the patient is a 33-year-old female who experienced trauma followed by abdominal and lower back pain, and given that the CT scans show a substantial retroperitoneal mass with mixed high density, together with the possibility of decreased hemoglobin levels and shock, the most likely diagnosis is a trauma-induced retroperitoneal hematoma. If conditions allow, laboratory tests (including hemoglobin levels, white blood cell count, coagulation function, etc.) and follow-up imaging studies should be performed to confirm the diagnosis and assess the extent of bleeding.

IV. Treatment Options and Rehabilitation Plan

1. Treatment Strategy

• Conservative Treatment: Appropriate for patients with a stable hematoma, a clear tendency to stop bleeding, no obvious progressive decrease in hemoglobin, and no severe hemodynamic instability. This approach includes bed rest, fluid replacement, blood transfusions if necessary to correct anemia, and close monitoring of vital signs.
• Interventional Therapy: If there is suspicion of major vascular injury (e.g., aorta or its branches), angiography and embolization can be considered for hemostasis.
• Surgical Treatment: Indicated when there is evidence of continuous hematoma expansion, active bleeding, or suspected organ rupture. Surgery may be required for hematoma evacuation or organ repair.

2. Rehabilitation/Exercise Prescription Recommendations

Because a retroperitoneal hematoma can cause pain and potentially compromise hemodynamic stability, strict bed rest and monitoring of vital signs are essential during the initial phase. Once the hematoma stabilizes and clinical/laboratory indicators improve, progressive exercise initiation can follow:

• Early Phase (1-2 weeks after hematoma stabilization):
  • Frequency: 1-2 times a day
  • Intensity: Low-intensity active exercises, such as gentle isometric lower limb contractions in bed, elevating the legs at a 5-10° angle
  • Time: 5-10 minutes per session
  • Type: Primarily basic activation exercises targeting core and lower limb muscle groups
  • Progression: Gradually increase repetitions and duration based on pain relief and stable hemoglobin levels
• Intermediate Phase (2-4 weeks):
  • Frequency: 3-4 times a week
  • Intensity: Moderate intensity; begin carefully supervised walking or mild stretching if tolerated
  • Time: 15-20 minutes per session
  • Type: Strengthening endurance of core and lower back muscles, such as low-intensity planks or bridging (if pain permits)
  • Progression: Increase walking distance or movement range based on the patient’s tolerance
• Late Phase (4 weeks onwards):
  • Frequency: 4-5 times a week
  • Intensity: Moderate to moderately high intensity, involving functional training such as balance exercises and light resistance work
  • Time: 20-30 minutes per session
  • Type: Focus on strengthening core and lower back muscles and improving lower limb strength for better overall function and stability
  • Progression: Gradually resume moderate daily activities or slow jogging (if not contraindicated) under the guidance of rehabilitation professionals

Pay close attention to the patient’s pain level, blood pressure, heart rate, and other discomforts throughout rehabilitation. If severe pain, dizziness, or tachycardia occurs, stop exercising immediately and consult the attending physician or physical therapist for further evaluation.

Disclaimer: This report is a reference analysis based on the currently available information and cannot replace an in-person consultation or professional medical advice. Please seek further clinical evaluation and treatment under the guidance of qualified healthcare professionals.