Massive Psoas Muscle Bleeding from the Contralateral Lumbar Artery Obscured by a Lumbar Vertebra Fracture: A Case Report.

Lumbar artery injury is a rare but potentially life-threatening consequence of blunt trauma. We report the case of an 84-year-old man who presented with right-sided chest and back pain and hypotension following a 3-m fall from a bicycle. Contrast-enhanced CT revealed burst fractures of the L2 and L4 vertebrae, massive contrast extravasation in the left psoas muscle, and a smaller blush in the right psoas muscle, suggesting left lumbar artery injury. Angiography revealed active bleeding from the right L3 lumbar artery, with contrast extravasation extending through the fractured vertebral body into the contralateral psoas muscle. Endovascular embolization achieved complete hemostasis and the patient was subsequently stabilized. This case illustrates a rare diagnostic pitfall, in which vertebral fractures may obscure contralateral lumbar arterial bleeding, emphasizing the importance of careful CT evaluation and angiographic confirmation in patients with trauma.