Retroperitoneal hematoma presenting as an adnexal mass after femoral catheterization

One complication of femoral artery catheterization is postprocedure pelvic hematoma. These hematomas can be difficult to differentiate from adnexal masses.

Two women who had undergone femoral artery catheterization presented with pelvic pain within 3 months of the procedure. Imaging studies revealed a nonspecific adnexal mass, and CA 125 levels were normal. Both women underwent exploratory laparotomy for an adnexal mass and were found to have an organized retroperitoneal hematoma.

An organizing or well-formed retroperitoneal hematoma should be added to the differential diagnosis in a patient with a poorly defined adnexal mass who has had a recent femoral artery catheterization. In patients with a mass less than 10 cm and normal CA 125 (less than 35 units/mL), continued close observation or magnetic resonance imaging scan may be considered.