A 38 y.o. male comes in with severe hip pain. He had been unconscious after a fentanyl OD.

The pt had been on the floor for 8 hours.

Do you notice anything on the CT? Hint: it is in the muscle on the right.

Our patient did not get a CT but the same diagnosis was made: gluteal compartment syndrome.  In the CT shown there is swelling in the gluteal muscles  which is more easily seen on MRI.

Swelling in the right gluteal muscles on MRI

Gluteal compartment syndrome is most often seen in individuals who are lying in one position for a long period of time; often after a drug overdose as in our patient.  Gluteal compartment syndrome is associated with  sciatic nerve palsy, massive rhabdomyolysis, renal failure, multiple organ failure and death. Cases have been reported of delayed diagnosis after falls, and clinicians should have a high index of suspicion for the syndrome.  Delayed diagnosis leads to profound disability.

In our patient only the gluteus medius and gluteus minimus were involved.

Our patient was recognized early because of a tense compartment and severe pain. He did not receive imaging but had a surgery consult, a compartment pressure, and went to the OR . A three compartment fasciotomy was done.

References

Hill S, Bianchi.  The gluteal compartment syndrome. 1997. Am Surg.Sep 63((): 823-6

Mustafa N, Hyun A, Kumar J, et al. Gluteal compartment syndrome: a case report. 2009.  Cases J.  2:190. Doi: 10.1186/1757-1626-2-190.

Yoshioka  H.  Gluteal compartment syndrome. 1992. Acta Orthopaedica Scandinavica, 63:3, 347-349. DOI:10.3109/17453679209154800

Remember crush injuries also can cause a compartment syndrome.