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Bilateral iliopsoas hematoma: Case report and literature review.

Basheer A, Jain R, Anton T, Rock J - Surg Neurol Int (2013)

Bottom Line: The intramuscular hematoma causes severe pain, muscle dysfunction, and occasionally nerve palsy with the femoral nerve most commonly affected.Most patients are neurologically normal but when a significant neurological deficit is associated with iliopsoas hematoma, optimal treatment recommendations vary.Surgical evacuation and decompression of the femoral nerves was performed with rapid neurological improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA.

ABSTRACT

Background: Clinically significant spontaneous bilateral iliopsoas hematoma is a rare complication of anticoagulation therapy. Definitive treatment of spontaneous iliopsoas hematomas is not well-established and varies between observation and surgical intervention. The intramuscular hematoma causes severe pain, muscle dysfunction, and occasionally nerve palsy with the femoral nerve most commonly affected. Most patients are neurologically normal but when a significant neurological deficit is associated with iliopsoas hematoma, optimal treatment recommendations vary. We report a case of spontaneous bilateral iliopsoas hematomas causing significant bilateral femoral nerve dysfunction.

Case description: The authors present the case of a 63-year-old female who developed bilateral femoral nerve palsy due to anticoagulation bleeding complication. Magnetic resonance imaging demonstrated large bilateral intramuscular psoas hematomas causing femoral nerve compression. Surgical evacuation and decompression of the femoral nerves was performed with rapid neurological improvement.

Conclusion: Management recommendations depend on the volume and cause of the hematoma, timing of diagnosis, and the degree of neurological impairment. A conservative approach with bed rest and correction of bleeding abnormalities to allow the hematoma to spontaneously resorb has been utilized for patients with small hematomas and little to no neurological symptoms. In contrast, more aggressive recommendations have been made for patients with large hematomas, severe motor function deficits, or hemodynamic instability.

No MeSH data available.


Related in: MedlinePlus

(a) Axial T2, (b) precontrast T1, and (c) postcontrast T1-weighted axial MR images of the lumbar spine showing markedly enlarged bilateral iliac muscles containing heterogeneous hematomas, which also show fluid–fluid level on axial T2-weighted images
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Figure 1: (a) Axial T2, (b) precontrast T1, and (c) postcontrast T1-weighted axial MR images of the lumbar spine showing markedly enlarged bilateral iliac muscles containing heterogeneous hematomas, which also show fluid–fluid level on axial T2-weighted images

Mentions: On day 7 of hospitalization, the patient developed moderate weakness in the proximal lower extremities. A CT scan of the abdomen was performed and demonstrated large, bilateral iliopsoas muscle hematomas. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated acute hematoma formation in the iliopsoas bilaterally [Figure 1a-c]. Neurosurgery was consulted on day 8. On physical examination, the patient was in no apparent distress and stable hemodynamically. She had normal tone, but moderate bilateral proximal lower extremity weakness with 3/5 strength in bilateral iliopsoas and 2/5 strength in quadriceps. Extension of the hip elicited pain in the back and groin. The patient also exhibited hyperalgesia and numbness over the L2-L4 dermatomes, bilaterally.


Bilateral iliopsoas hematoma: Case report and literature review.

Basheer A, Jain R, Anton T, Rock J - Surg Neurol Int (2013)

(a) Axial T2, (b) precontrast T1, and (c) postcontrast T1-weighted axial MR images of the lumbar spine showing markedly enlarged bilateral iliac muscles containing heterogeneous hematomas, which also show fluid–fluid level on axial T2-weighted images
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815018&req=5

Figure 1: (a) Axial T2, (b) precontrast T1, and (c) postcontrast T1-weighted axial MR images of the lumbar spine showing markedly enlarged bilateral iliac muscles containing heterogeneous hematomas, which also show fluid–fluid level on axial T2-weighted images
Mentions: On day 7 of hospitalization, the patient developed moderate weakness in the proximal lower extremities. A CT scan of the abdomen was performed and demonstrated large, bilateral iliopsoas muscle hematomas. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated acute hematoma formation in the iliopsoas bilaterally [Figure 1a-c]. Neurosurgery was consulted on day 8. On physical examination, the patient was in no apparent distress and stable hemodynamically. She had normal tone, but moderate bilateral proximal lower extremity weakness with 3/5 strength in bilateral iliopsoas and 2/5 strength in quadriceps. Extension of the hip elicited pain in the back and groin. The patient also exhibited hyperalgesia and numbness over the L2-L4 dermatomes, bilaterally.

Bottom Line: The intramuscular hematoma causes severe pain, muscle dysfunction, and occasionally nerve palsy with the femoral nerve most commonly affected.Most patients are neurologically normal but when a significant neurological deficit is associated with iliopsoas hematoma, optimal treatment recommendations vary.Surgical evacuation and decompression of the femoral nerves was performed with rapid neurological improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202, USA.

ABSTRACT

Background: Clinically significant spontaneous bilateral iliopsoas hematoma is a rare complication of anticoagulation therapy. Definitive treatment of spontaneous iliopsoas hematomas is not well-established and varies between observation and surgical intervention. The intramuscular hematoma causes severe pain, muscle dysfunction, and occasionally nerve palsy with the femoral nerve most commonly affected. Most patients are neurologically normal but when a significant neurological deficit is associated with iliopsoas hematoma, optimal treatment recommendations vary. We report a case of spontaneous bilateral iliopsoas hematomas causing significant bilateral femoral nerve dysfunction.

Case description: The authors present the case of a 63-year-old female who developed bilateral femoral nerve palsy due to anticoagulation bleeding complication. Magnetic resonance imaging demonstrated large bilateral intramuscular psoas hematomas causing femoral nerve compression. Surgical evacuation and decompression of the femoral nerves was performed with rapid neurological improvement.

Conclusion: Management recommendations depend on the volume and cause of the hematoma, timing of diagnosis, and the degree of neurological impairment. A conservative approach with bed rest and correction of bleeding abnormalities to allow the hematoma to spontaneously resorb has been utilized for patients with small hematomas and little to no neurological symptoms. In contrast, more aggressive recommendations have been made for patients with large hematomas, severe motor function deficits, or hemodynamic instability.

No MeSH data available.


Related in: MedlinePlus