343 posters, 5 videos, 2 audios, 18 topics, 33 sessions, 263 authors, 202 institutions

24th Annual Pain Medicine Meeting 2025

November 13-15, 2025| JW Marriott Austin, Austin, Texas

2195074

Caudal Epidural Steroid Injection for Refractory Leg Pain from a Psoas Mass

$Preview of Caudal Epidural Steroid Injection for Refractory Leg Pain from a Psoas Mass$

Scientific Abstracts > Acute Pain

Caudal Epidural Steroid Injection for Refractory Leg Pain from a Psoas Mass

Jeremy Foreman MD, Sahithi Katragadda MD, Lee Tian MD, Magdalena Anitescu MD

BACKGROUND:

•Vascular and neural compression can produce severe pain often resistant to multimodal medical therapy

•When etiology is unclear and pain is refractory to medications, interventional options may provide relief while diagnostic workup continues

•Caudal epidural steroid injections offer targeted analgesia while minimizing systemic adverse effects of traditional medications

METHODS:

•61-year-old female with history of recurrent grade II endometrial carcinoma status post-chemotherapy and pelvic tumor debulking

•Presented with new, severe left leg pain, swelling, and weakness unresponsive to multimodal pain regimen

•Procedure: caudal epidural steroid injection with catheter threaded to L5 with fluoroscopy

•Injectate: 2mL 1% Lidocaine + 2mL normal saline + 80mg methylprednisolone

•Followed by acute pain service for daily checks and progress notes

Targeted caudal epidural steroid injection provided rapid pain relief in a patient with a large psoas mass causing vascular and neural compression

Image 1: CT Venogram Abdomen Pelvis demonstrating an approximate 11cm x 9cm left iliopsoas mass

ADDITIONAL FINDINGS:

•Initial Laboratory Studies:

•WBC 84,800 (leukocytosis)

•Hgb 7.3 (anemia)

•Imaging Studies:

•CT Venogram Abd Pelvis: 11.3 x 8.9cm left iliopsoas mass compressing external iliac vein (see middle)

•MRI: Partial compression of left lumbosacral plexus

RESULTS:

•Pain decreased from 10/10 pre-procedure -> 7/10 on day 1 -> ~5/10 by day 5

•Sustained 40-50% average reduction in pain after 5 days post-injection

•No new neurological deficits or complications

•Improved tolerance for positioning and transport -> enabled iliac vein stent placement and IR-guided biopsy of mass

•Mass identified as recurrent endometrial carcinoma; palliative radiation initiated

•Significant edema and weakness persisted in left leg despite pain relief.

DISCUSSION:

•Caudal epidural steroid injections are typically utilized for radicular pain caused by disc herniation or spinal stenosis

•This case demonstrates a novel application of CESI for pain from a psoas mass causing both lumbosacral plexopathy and vascular compression

•Targeted epidural therapy provided effective palliation and served as a bridge to definitive diagnosis and subsequent therapeutic interventions