1
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Al F, Köroglu M, Özdeş HU, Aslantürk O. Iliacus hematoma causing late femoral nerve palsy. Clin Case Rep 2024; 12:e8654. [PMID: 38464580 PMCID: PMC10920301 DOI: 10.1002/ccr3.8654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Femoral nerve palsy is rare and may progress insidiously, leading to late clinical presentation. Identifying the underlying cause is very important for treatment. An iliacus hematoma causing nerve palsy is perhaps the most innocent etiology. However, this hematoma sometimes causes only abdominal pain and may even be misdiagnosed as a late intra-abdominal pathology.
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Affiliation(s)
- Fırat Al
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Muhammed Köroglu
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
| | - Hüseyin Utku Özdeş
- Yesilyurt Hasan Çalık State Hospital Orthopedics and TraumatologyMalatyaTurkey
| | - Okan Aslantürk
- Department of Orthopedics and TraumatologyInonu University Faculty of MedicineMalatyaTurkey
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2
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Guild TT, Crawford AM, Striano BM, Mortensen S, Wixted JJ. The epidemiology and management of iliopsoas hematoma with femoral nerve palsy: A descriptive systematic review of 174 cases. Injury 2023; 54:280-287. [PMID: 36586813 DOI: 10.1016/j.injury.2022.11.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/18/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Iliopsoas hematoma with femoral nerve palsy is a rare phenomenon with no consensus treatment algorithm. The objective of this study was to perform a systematic review of all reported cases of femoral nerve palsy secondary to iliopsoas hematoma to better elucidate it's optimal treatment. MATERIALS AND METHODS Queries of the PubMed, Embase, and Cochrane databases were performed for reports available in English of femoral nerve palsy secondary to iliopsoas, psoas, or iliacus hematoma. 1491 articles were identified. After removal of duplicated publications and review of abstract titles via a majority reviewer consensus, 217 articles remained for consideration. Dedicated review of the remaining articles (including their reference sections) yielded 122 articles representing 174 distinct cases. Clinical data including patient age, sex, medical history, use of pharmacologic anticoagulation, sensory and motor examination at presentation and follow-up, hematoma etiology and location, time to intervention, and type of intervention were collected. Descriptive statistics were generated for each variable. RESULTS Femoral nerve palsy secondary to iliopsoas hematoma occurred at a mean age of 44.5 years old. A majority of patients (60%) were male, and a majority of hematomas (54%) occurred due to pharmacologic anticoagulation. Most hematomas (57%) were treated conservatively, and almost half (49%) - regardless of treatment modality - resulted in persistent motor deficits at final follow-up. A minority of patients treated surgically (34%) had residual motor deficit at final follow-up, while 66% of those treated medically had resultant motor deficits, although no direct statistical comparison was able to be performed. DISCUSSION AND CONCLUSIONS The disparate available data on iliopsoas hematoma with femoral nerve palsy precludes the completion of a true metanalysis, and therefore any conclusions on an optimal treatment algorithm. Based on review of the literature, small to moderate hematomas are often treated conservatively, while larger hematomas with progressive neurological symptoms are usually managed with a percutaneous decompression or surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Theodore T Guild
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA.
| | - Alexander M Crawford
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Harvard Medical School, Boston, MA
| | - Sharri Mortensen
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Boston, MA
| | - John J Wixted
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Kim TH, Lee DJ, Kim W, Do HK. Compressive femoral neuropathy caused by anticoagulant therapy induced retroperitoneal hematoma: A case report. Medicine (Baltimore) 2022; 101:e28876. [PMID: 35363199 PMCID: PMC9282122 DOI: 10.1097/md.0000000000028876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Spontaneous retroperitoneal hematomas due to anticoagulant therapy rarely occur. Retroperitoneal hematomas can cause severe pain in the groin, quadriceps femoris muscle weakness, hemodynamic instability, and abdominal distension. They rarely cause compressive neuropathy of the femoral nerve transversing the iliacus muscle. Differential diagnosis is not easy because they have similar clinical features to retroperitoneal hematomas. PATIENT CONCERNS A 72-year-old female patient whose right arm was stuck in a bookshelf for 5 days developed right cephalic vein thrombosis. After 5 days of intravenous heparin therapy for venous thrombosis, she presented with sudden right groin pain, right leg paresis, hemodynamic instability, and abdominal distension. DIAGNOSIS Emergency abdominal and pelvic CT showed a large number of hematomas in the bilateral retroperitoneal space with active bleeding of the right lumbar artery. An electrodiagnostic study was performed 2 weeks later to check for neuromuscular damage in the right lower extremity, and right compressive femoral neuropathy was confirmed. INTERVENTIONS Heparin therapy was discontinued; emergency embolization of the lumbar artery was performed. After 2 weeks, the patient started receiving physical, occupational, and transcutaneous electrical stimulation therapies. OUTCOMES She became hemodynamically stable after arterial embolization; a significant decrease in hematoma and patency of the femoral nerve was confirmed on follow-up pelvic MRI. After 2 months of comprehensive rehabilitation, the muscle strength of the right leg significantly improved, and the pain disappeared. LESSONS Although rare, spontaneous retroperitoneal hematomas may occur in patients receiving anticoagulant medications. They may even occur in patients receiving emergency anticoagulant therapy. Compressive femoral neuropathy due to retroperitoneal hematomas should be considered if muscle weakness and groin pain are observed. Early diagnosis and appropriate treatment plan of compressive femoral neuropathy due to retroperitoneal hematoma are helpful for a good prognosis.
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Affiliation(s)
- Tae-Hoon Kim
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Da-Jung Lee
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Wanil Kim
- Department of Biochemistry, Department of Convergence Medical Science, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Hwan-Kwon Do
- Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
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Vergori A, Pianura E, Lorenzini P, D’Abramo A, Di Stefano F, Grisetti S, Vita S, Pinnetti C, Donno DR, Marini MC, Nicastri E, Ianniello S, Antinori A. Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients. Ann Med 2021; 53:295-301. [PMID: 33491498 PMCID: PMC7877978 DOI: 10.1080/07853890.2021.1875498] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/09/2021] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment. MATERIALS AND METHODS We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy. RESULTS Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis. CONCLUSIONS Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.
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Affiliation(s)
- Alessandra Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Elisa Pianura
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Patrizia Lorenzini
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Alessandra D’Abramo
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Federica Di Stefano
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Susanna Grisetti
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Serena Vita
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Carmela Pinnetti
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Davide Roberto Donno
- Severe and Immune-depression Associated Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Maria Cristina Marini
- Intensive Care Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Emanuele Nicastri
- Emerging Infectious Diseases Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Stefania Ianniello
- Radiology Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Andrea Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS, Rome, Italy
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Management of Spontaneous Bleeding in COVID-19 Inpatients: Is Embolization Always Needed? J Clin Med 2021; 10:jcm10184119. [PMID: 34575230 PMCID: PMC8469448 DOI: 10.3390/jcm10184119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/02/2021] [Accepted: 09/09/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND critically ill patients with SARS-CoV-2 infection present a hypercoagulable condition. Anticoagulant therapy is currently recommended to reduce thrombotic risk, leading to potentially severe complications like spontaneous bleeding (SB). Percutaneous transcatheter arterial embolization (PTAE) can be life-saving in critical patients, in addition to medical therapy. We report a major COVID-19 Italian Research Hospital experience during the pandemic, with particular focus on indications and technique of embolization. METHODS We retrospectively included all subjects with SB and with a microbiologically confirmed SARS-CoV-2 infection, over one year of pandemic, selecting two different groups: (a) patients treated with PTAE and medical therapy; (b) patients treated only with medical therapy. Computed tomography (CT) scan findings, clinical conditions, and biological findings were collected. RESULTS 21/1075 patients presented soft tissue SB with an incidence of 1.95%. 10/21 patients were treated with PTAE and medical therapy with a 30-days survival of 70%. Arterial blush, contrast late enhancement, and dimensions at CT scan were found discriminating for the embolization (p < 0.05). CONCLUSIONS PTAE is an important tool in severely ill, bleeding COVID-19 patients. The decision for PTAE of COVID-19 patients must be carefully weighted with particular attention paid to the clinical and biological condition, hematoma location and volume.
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Crawford AM, Guild TT, Striano BM, Von Keudell AG. Spontaneous iliacus haematoma with femoral nerve palsy: an appeal to involve surgical teams early. BMJ Case Rep 2021; 14:14/1/e239024. [PMID: 33462039 PMCID: PMC7816894 DOI: 10.1136/bcr-2020-239024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
We report the case of a 68-year-old man who was placed on heparin as bridge therapy and subsequently developed an iliacus haematoma with associated femoral nerve palsy. His team involved the orthopaedic surgery team in delayed fashion after his symptom onset. Due to his active medical conditions, he did not undergo surgical decompression of his haematoma until late into his hospital course. Unfortunately, this patient did not regain meaningful function from his femoral nerve deficit. We believe this case highlights the high index of suspicion necessary for making this diagnosis as well as the repercussions of an untimely decompression for this acute, compressive neuropathy. Although we are surgeons and this is a surgical case, we hope to publish this case in a medical journal to raise awareness that surgical decompression does have a role in this diagnosis and should ultimately be pursued early in its course for optimal patient benefit.
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Affiliation(s)
| | - Theodore T Guild
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
| | - Brendan M Striano
- Harvard Combined Orthopaedic Residency Program, Boston, Massachusetts, USA
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7
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Abstract
In patients with hemophilia, the usual treatment for both iliopsoas hematoma and associated femoral nerve compression is conservative. The case presented herein is a moderate hemophilia A patient with significant femoral neuropathy due to iliopsoas hematoma whose symptoms could not be managed with an aggressive factor VIII replacement program for >2 weeks. An unusual treatment option - percutaneous catheter insertion and aspiration of the hematoma - alleviated the examination findings and reversed his abilities.
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8
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Kim SJ, Park HS, Lee DW. Iliacus hematoma syndrome: A systematic review of recent literature and case report. Injury 2020; 51:1744-1750. [PMID: 32487330 DOI: 10.1016/j.injury.2020.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/06/2020] [Accepted: 05/10/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Femoral nerve palsy caused by iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. However, due to potentially devastating outcomes, prompt recognition and management are essential. OBJECTIVES The aim with this study was to better characterize clinical presentation, diagnosis, treatment, and prognosis of iliacus hematoma. METHODS We performed a systematic review of recent literature regarding femoral neuropathy secondary to an iliacus hematoma. A structured literature review of multiple databases ((PubMed, Web of Science, EMBASE, and Cochrane library) referenced articles from 2000 to 2019. RESULTS A total of 25 patients from 25 published studies were identified. The average age of the patients was forty years (range, 12 to 85 years). There were 16 male patients and 9 female patients. The single most important predisposing cause of iliacus hematoma was trauma (14/25), with a pooled percentage of 56%. All patients with spontaneous hematoma were taking antiplatelet medications. Thirteen patients (52%) were treated conservatively with analgesia. Surgical decompression was performed in 10 patients (40%). At the final follow-up, complete resolution of symptoms was achieved in 12 patients (48%). CONCLUSIONS Although rare, iliacus hematoma syndrome carries significant morbidity. Spontaneous iliacus muscle hematoma should be considered in the differential diagnosis of leg pain in a patient who is on anticoagulation therapy. In patients with an iliacus hematoma and neurology deficit, conservative treatment can be considered initially if there is no progression in the symptoms evident at the time of presentation. However, prompt surgical decompression has been highly recommended in patients with progressive neurological deficits.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Republic of Korea.
| | - Hyun-Soo Park
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Republic of Korea.
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, Republic of Korea.
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9
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Watanabe Y, Koutoku H, Nagata H, Oda Y, Kikuchi H, Kojima M. Rhabdomyolysis with Acute Kidney Injury Caused by Bilateral Iliopsoas Hematoma in a Patient with Atrial Fibrillation. Intern Med 2019; 58:2887-2890. [PMID: 31243202 PMCID: PMC6815887 DOI: 10.2169/internalmedicine.2749-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Rhabdomyolysis is a relatively common and life-threatening disease that is sometimes complicated by acute kidney injury (AKI). Several causes have been reported, divided into traumatic and non-traumatic causes. We herein report a patient with rhabdomyolysis with AKI caused by bilateral iliopsoas hematoma. This patient had atrial fibrillation that was poorly controlled with warfarin, and bilateral iliopsoas hematoma was caused by turnover without a history of high-energy injury. Treatment with the rapid neutralization of warfarin improved his clinical condition without complications. We should pay close attention to episodes of turnover among elderly patients receiving anticoagulant therapy.
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Affiliation(s)
- Yusuke Watanabe
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Honoka Koutoku
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Hiroyuki Nagata
- Department of Internal Medicine, Hitachiomiya Saiseikai Hospital, Japan
| | - Yuya Oda
- Department of Internal Medicine, National Health Insurance Miwa Clinic, Japan
| | - Hitoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Mito Saiseikai General Hospital, Japan
| | - Masayuki Kojima
- Department of Surgery, Hitachiomiya Saiseikai Hospital, Japan
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10
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Ha YS, Park YS. Various Complications after a Vascular Procedure in Patients with Hemophilia. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2019. [DOI: 10.15264/cpho.2019.26.1.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Yeon Soo Ha
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young Shil Park
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Seoul, Korea
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11
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Kheiri B, Al Salihi M, Maldonado D, Nakhleh R, Bachuwa G. Warfarin-induced spontaneous iliopsoas hematoma - An unusual complication. Clin Case Rep 2018; 6:1639-1640. [PMID: 30147925 PMCID: PMC6099004 DOI: 10.1002/ccr3.1665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/14/2018] [Accepted: 06/06/2018] [Indexed: 12/02/2022] Open
Abstract
Warfarin is a commonly prescribed anticoagulant with a narrow therapeutic window and high potential for serious complications. Spontaneous psoas hematoma is a rare complication of warfarin which can result in significant neurological deficits.
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Affiliation(s)
- Babikir Kheiri
- Internal Medicine DepartmentHurley Medical Center/Michigan State UniversityFlintMIUSA
| | - Mohammed Al Salihi
- Internal Medicine DepartmentHurley Medical Center/Michigan State UniversityFlintMIUSA
| | - David Maldonado
- Internal Medicine DepartmentHurley Medical Center/Michigan State UniversityFlintMIUSA
| | - Rasha Nakhleh
- Internal Medicine DepartmentHurley Medical Center/Michigan State UniversityFlintMIUSA
| | - Ghassan Bachuwa
- Internal Medicine DepartmentHurley Medical Center/Michigan State UniversityFlintMIUSA
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12
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Nefiss M, Tebourbi A, Ben Maatoug A, Bouzidi R. Femoral nerve paralysis complicating a post-traumatic iliopsoas haematoma. BMJ Case Rep 2018; 2018:bcr-2017-220446. [PMID: 29930178 DOI: 10.1136/bcr-2017-220446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Paralysis of the femoral nerve secondary to iliopsoas haematoma is a rare post-traumatic complication. Because of the large differential diagnosis, a high level of suspicion is required for its early recognition. Treatment modalities are controversial due to the rarity of this entity. An 18-year-old student presented with complete paralysis of the knee extensors and a sensory deficit on the anterior side of the thigh 5 weeks after a sport accident. MRI of the lesser pelvis showed an iliopsoas haematoma. Surgical decompression was performed and recovery was complete at 6 months of follow-up.
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Affiliation(s)
- Mouadh Nefiss
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Anis Tebourbi
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Aymen Ben Maatoug
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
| | - Ramzi Bouzidi
- Department Of Orthopedic Surgery, Tunis El Manar University, Faculty Of Medecine, Tunis, Tunisia
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13
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Andreani L, Nucci AM, Giuntoli M, Lisanti M. Compressive Femoral Neuropathy Associated with Iliopsoas Hematoma Complicating Hip Hemiarthroplasty: A Case Report. J Orthop Case Rep 2017; 7:3-6. [PMID: 29242785 PMCID: PMC5727995 DOI: 10.13107/jocr.2250-0685.872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Femoral nerve compression caused by iliopsoas hematoma is a rare complication after hip surgery. To the best of our knowledge, this is the first case after hemiarthroplasty. In this case, iliacus hematoma resulted from spontaneous bleeding favored by anticoagulant therapy. Case Report A 78-year-old female developed left groin pain associated with typical symptoms of femoral nerve palsy about 2weeks after left hip hemiarthroplasty[1, 2, 3]. Computed tomography revealed the presence of a left iliopsoas hematoma that was surgically drained. Inguinal pain was immediately relieved, while nerve palsy recovered only partially, but the quality of life drastically improved and she was able to walk using a walker without pain. Conclusion Even if it is a rare condition, the formation of a hematoma of iliopsoas muscle should be considered in patients that present symptoms of femoral nerve palsy, especially if treated with heparin or other anticoagulant drugs. Surgical drainage of the hematoma is indicated when symptoms are severe and disabling, and in this way, surgery could improve quality of life.
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Affiliation(s)
- L Andreani
- Department of Orthopaedics and Traumatology, University of Pisa, Pisa - 56126, Italy
| | - A M Nucci
- Department of Orthopaedics and Traumatology, University of Pisa, Pisa - 56126, Italy
| | - M Giuntoli
- Department of Orthopaedics and Traumatology, University of Pisa, Pisa - 56126, Italy
| | - M Lisanti
- Department of Orthopaedics and Traumatology, University of Pisa, Pisa - 56126, Italy
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14
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Mwipatayi BP, Daneshmand A, Bangash HK, Wong J. Delayed iliacus compartment syndrome following femoral artery puncture: case report and literature review. J Surg Case Rep 2016; 2016:rjw102. [PMID: 27273684 PMCID: PMC4893731 DOI: 10.1093/jscr/rjw102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Iliacus compartment syndrome is a rare retroperitoneal compartment neuropathy caused by bleeding within the iliacus muscle leading to hematoma formation and compression upon the femoral nerve, causing both sensory and motor deficits. A 75-year-old Caucasian man presented with severe right hip pain associated with motor and sensory deficit in the right lower extremity, 2 weeks post elective balloon aortic valvuloplasty for critical aortic stenosis. A non-contrast computed tomography scan revealed low-attenuation areas in keeping with an iliacus hematoma. An iliacus fasciotomy and hematoma evacuation was performed with retroperitoneal approach. The patient reported marked reduction in his groin pain with clinical improvement of the right hip flexion though the sensory deficit was unchanged. On Day 3, postoperatively the patient died from respiratory and multi-organ failure. Iliac hematomas are rare and can be caused by traumatic and non-traumatic injury, and can be exacerbated by complications of anticoagulant therapy. Delaying surgical evacuation of the hematoma can lead to prolonged or permanent disability. However, there are other reports describing good recovery with non-operative management. Non-surgical intervention is recommended if radiological studies do not explicitly confirm the presence of a discreet hematoma compressing the femoral nerve, unless progression of symptoms increases.
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Affiliation(s)
- Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth WA 6000, Australia
| | - Ali Daneshmand
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Haider K Bangash
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Jackie Wong
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
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Lee S, Goetz T, Gharapetian A. Unanticipated Motor Weakness with Ultrasound-Guided Transversalis Fascia Plane Block. ACTA ACUST UNITED AC 2015; 5:124-5. [DOI: 10.1213/xaa.0000000000000237] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Sallahi H, Margad O, Lamkhantar A, Idrissi KK. [Posttraumatic hematoma of the Iliopsoas muscle with femoral nerve palsy: about a case report and review of literature]. Pan Afr Med J 2015; 20:198. [PMID: 26113929 PMCID: PMC4469513 DOI: 10.11604/pamj.2015.20.198.6265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/21/2015] [Indexed: 11/24/2022] Open
Abstract
L'hématome compressif du muscle iliopsoas dans le petit bassin est une complication connue des traitements anticoagulants, mais reste rare en post-traumatique. La présente observation illustre un cas de cet hématome chez un adolescent de 14 ans qui s'est présenté avec une douleur post-traumatique de la cuisse et un déficit actif d'extension de la jambe évoluant depuis plus de 3 mois. Un examen clinique a montré l'existence d'une paralysie complète du quadriceps. Une IRM du petit bassin a retrouvé un volumineux hématome du muscle iliopsoas comprimant le nerf fémoral. Un drainage chirurgical de l'hématome a été réalisé. La récupération musculaire était partielle après six mois de recul.
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Affiliation(s)
- Hicham Sallahi
- Service de Traumatologie-Orthopédie, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Omar Margad
- Service de Traumatologie-Orthopédie, Hôpital Militaire Avicenne, Marrakech, Maroc
| | - Adil Lamkhantar
- Service de Traumatologie-Orthopédie, Hôpital Militaire Mohamed V, Rabat, Maroc
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Miyagawa S, Arai A, Mitsumura H, Iguchi Y. [Ultrasound findings of hamstring hematoma in a patient taking anticoagulants]. Rinsho Shinkeigaku 2015; 55:353-5. [PMID: 26028200 DOI: 10.5692/clinicalneurol.cn-000639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A patient started anticoagulation for secondary prevention of stroke, achieving a prothrombin time-international normalized ratio within the optimal therapeutic range. The patient subsequently complained of pain in the left thigh on hospital day 25, and ultrasonography showed a large intramuscular hematoma in the left hamstring. The intramuscular hematoma gradually reduced without surgical intervention. Ultrasound examination plays an important role in precisely diagnosing intramuscular hematoma and monitoring changes in hematoma size.
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Affiliation(s)
- Shinji Miyagawa
- Department of Neurology, The Jikei University School of Medicine
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18
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Fernandes C, Pereira P, Rodrigues M. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)? BMJ Case Rep 2015; 2015:bcr-2014-206410. [PMID: 25750219 DOI: 10.1136/bcr-2014-206410] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome.
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Affiliation(s)
| | - Pedro Pereira
- Neurology Department, Hospital Garcia de Orta, Almada, Portugal
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19
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Treatment of muscle haematomas in haemophiliacs with special emphasis on percutaneous drainage. Blood Coagul Fibrinolysis 2014; 25:787-94. [DOI: 10.1097/mbc.0000000000000159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Complete paralysis of the quadriceps secondary to post-traumatic iliopsoas hematoma: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 25:39-43. [PMID: 23996110 DOI: 10.1007/s00590-013-1305-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Paralysis of the femoral nerve secondary to compression by a hematoma of the iliopsoas is rarely post-traumatic. The acute surgical removal of hematoma seems the treatment of choice. The main objective of this systematic review was to determine the optimal delay between the trauma and surgery, to obtain a total functional recovery. METHODS A search was performed via PubMed. The inclusion criteria were the studies in English language, reporting the results of the treatment of femoral nerve palsy secondary to compression by a post-traumatic hematoma of the iliopsoas. The primary evaluation criterion was the clinical recovery of femoral nerve function. The secondary criteria were the delay of recovery and the delay between the trauma and surgery. RESULTS Thirteen studies were identified, only case reports. Sixteen patients were included, mean age 16.6 ± 3.4 years, 11 men and 5 women. The injury was associated with the sports practice in 12/16 (75 %) cases. Neurological symptoms developed about 5 days after injury. Femoral palsy was complete in 8 patients and partial in 8 patients. The mean delay between the injury and the diagnosis was 7.3 (2-25) days in conservative group and 17.8 (4-45) days in surgical group. Seven patients were managed conservatively, 6 partial paralysis and 1 total paralysis, and 9 surgically, 7 total paralysis and 2 partial paralysis. The recovery was total in 13/14 patients (seven surgical treatment and six conservative management) and partial in one patient who was managed conservatively despite a total paralysis. The delay of total recovery varied from 1 month to 6 weeks in conservative group and 3 months to 2 years in surgical group. CONCLUSION This systematic review seems to indicate that whatever the delay, surgery is necessary in case of complete paralysis of the femoral nerve secondary to compression from a post-traumatic hematoma of the iliopsoas muscle.
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Kuo HW, Ku JW, Chiang CJ, Rau G, Chen CY, Chen CH. Complete Femoral Nerve Palsy Following Traumatic Iliacus Hematoma: A Case Report and Literature Review. JBJS Case Connect 2013; 3:e74. [PMID: 29252613 DOI: 10.2106/jbjs.cc.l.00291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Hsiu-Wen Kuo
- Department of Radiology, Buddhist Tzuchi General Hospital Taipei Branch, No. 289, Jianguo Road, Xindian District, New Taipei City 23142, Taiwan
| | - Jan-Wen Ku
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Chang-Jung Chiang
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Gary Rau
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Chih-Yu Chen
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
| | - Chia-Hsien Chen
- Department of Radiology (J.-W.K.), Department of Orthopaedics (C.-J.C., G.R., C.-Y.C., C.-H.C.), Shuang-Ho Hospital, Taipei Medical University, Taipei, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561, Taiwan.
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22
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Ganu S, Mehta Y. Femoral compressive neuropathy from iliopsoas haematoma complicating dengue hemorrhagic fever. ASIAN PAC J TROP MED 2013; 6:419-20. [PMID: 23608387 DOI: 10.1016/s1995-7645(13)60052-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/15/2012] [Accepted: 02/01/2013] [Indexed: 11/30/2022] Open
Abstract
Dengue fever is a debilitating mosquito-borne disease caused by dengue virus. We reported a case of femoral compression neuropathy due to iliopsoas hematoma complicating dengue hemorrhagic fever. Iliopsoas muscle hematoma can cause femoral neuropathy with resultant pain and paralysis. Such manifestations are not well documented in the literature. The pathogenesis of hematoma and compressive neuropathy with its appropriate management is discussed.
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Affiliation(s)
- Sneha Ganu
- Department of Physiotherapy, MGM Hospital & College of Physiotherapy, Navi Mumbai, India.
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