INTRODUCTION: Hemophilic pseudotumor is a rare but well documented complication 
seen in approximately 1-2% of patients with hemophilia. The incidence continues 
to decrease, likely because of increasingly sophisticated techniques in managing 
factor deficiency. We present a case of hemophilic pseudotumor in a patient 
without hemophilia, an exceptionally rare entity, and outline a hybrid approach 
to treatment.
PRESENTATION OF CASE: The patient presented with a left sided iliopsoas mass and 
associated radiculopathy, with a history of a poorly characterized bleeding 
diathesis and Noonan's syndrome. He had no history of trauma and was not being 
treated with anti-coagulation. Of note, factors VIII, IX and XI were normal. An 
open biopsy was consistent with hemophilic pseudotumor. The patient underwent a 
hybrid procedure of preoperative embolization of the left internal iliac and 
left deep circumflex arteries followed by surgical debridement and resection, 
with an excellent outcome.
DISCUSSION: Hemophilic pseudotumor is rarely seen in patients with hemophilia, 
and even less frequently in patients without. Trauma is often the inciting 
event. A high index of clinical suspicion is required in order to secure the 
diagnosis, as the radiographic appearance is non-specific. Our patient had no 
history of trauma, although we question whether his underlying bleeding 
diathesis may have predisposed him to developing the pseudotumor. Surgery 
remains the cornerstone of management in these cases.
CONCLUSION: Within the literature, there are only two other cases of hemophilic 
pseudotumor occurring in a non-hemophiliac patient, highlighting the rarity of 
this case and the associated diagnostic dilemma.