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Alsaqobi AK, Miskin BA, Gopinath B, Elgohary G. More than what meets the eye in COVID-19 critical illness: A case report of bilateral femoral neuropathy due to psoas hematomas. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2024; 29:133-138. [PMID: 38740405 PMCID: PMC11305369 DOI: 10.17712/nsj.2024.2.20230072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Bilateral femoral neuropathy is rare, especially that caused by bilateral compressive iliopsoas, psoas, or iliacus muscle hematomas. We present a case of bilateral femoral neuropathy due to spontaneous psoas hematomas developed during COVID-19 critical illness. A 41-year-old patient developed COVID-19 pneumonia, and his condition deteriorated rapidly. A decrease in the hemoglobin level prompted imaging studies during his intensive care unit (ICU) stay. Bilateral psoas hematomas were identified as the source of bleeding. Thereafter, the patient complained of weakness in both upper and lower limbs and numbness in the lower limb. He was considered to have critical illness neuropathy and was referred to rehabilitation. Electrodiagnostic testing suggested bilateral femoral neuropathy because of compression due to hematomas developed during the course of his ICU stay. The consequences of iliopsoas hematomas occurring in the critically ill can be catastrophic, ranging from hemorrhagic shock to severe weakness, highlighting the importance of recognizing this entity.
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Affiliation(s)
- Ameerah K Alsaqobi
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
| | - Brouj A Miskin
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
| | - Biju Gopinath
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
| | - Ghada Elgohary
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
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Chalk C, Zaloum A. Femoral and obturator neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:183-194. [PMID: 38697739 DOI: 10.1016/b978-0-323-90108-6.00007-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The femoral and obturator nerves both arise from the L2, L3, and L4 spinal nerve roots and descend into the pelvis before emerging in the lower limbs. The femoral nerve's primary function is knee extension and hip flexion, along with some sensory innervation to the leg. The obturator nerve's primary function is thigh adduction and sensory innervation to a small area of the medial thigh. Each may be injured by a variety of potential causes, many of them iatrogenic. Here, we review the anatomy of the femoral and obturator nerves and the clinical features and potential etiologies of femoral and obturator neuropathies. Their necessary investigations, including electrodiagnostic studies and imaging, their prognosis, and potential treatments, are discussed in this chapter.
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Affiliation(s)
- Colin Chalk
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Austin Zaloum
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada.
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3
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El Boté H, Boughaleb A, Lakssir J, Bellouki O, El Anbari Y. Spontaneous Iliopsoas Hematoma in a Patient on Acenocoumarol: Report of a Rare Case. Cureus 2023; 15:e38730. [PMID: 37292568 PMCID: PMC10246924 DOI: 10.7759/cureus.38730] [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] [Accepted: 05/08/2023] [Indexed: 06/10/2023] Open
Abstract
Spontaneous hematoma of the iliopsoas is a rare pathological circumstance; in the majority of cases published in the literature, it is associated with disorders of hemostasis due to anticoagulant treatment or coagulopathies. We present a case of a 64-year-old man on acenocoumarol, an anticoagulant of the vitamin K antagonist family, for atrial fibrillation, who presented with a severe left hip and flank pain with a huge ecchymosis on the left flank and a partial inability to extend the left thigh. A CT scan confirmed the diagnosis of iliopsoas hematoma. Given the hemodynamic stability of the patient, he benefited from a conservative treatment with a favourable evolution. This case highlights the underlying conditions, diagnosis, and treatment of this uncommon complication.
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Affiliation(s)
- Hicham El Boté
- Surgery, Regional Hospital of Beni Mellal, Beni Mellal, MAR
| | | | - Jihad Lakssir
- Urology, Ibn Sina Hospital, University of Rabat, Rabat, MAR
| | - Omar Bellouki
- Urology, Ibn Sina Hospital, University of Rabat, Rabat, MAR
| | - Younes El Anbari
- Medicine, Regional Hospital Center of Beni Mellal, Beni Mellal, MAR
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Post-COVID-19 non-traumatic iliopsoas hematoma: A case report. J Taibah Univ Med Sci 2022; 18:61-64. [PMID: 35875171 PMCID: PMC9293483 DOI: 10.1016/j.jtumed.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/17/2022] [Accepted: 07/05/2022] [Indexed: 11/29/2022] Open
Abstract
Background Critically ill COVID-19 patients have an elevated risk of experiencing hypercoagulable conditions. Currently, many COVID-19 patients have been administered anticoagulation or antiplatelet therapies to lower the risk of systematic thrombosis. Iliopsoas hematoma is a potentially fatal and rare complication of bleeding disorders or anticoagulation therapy which sometimes grows to become clinically significant. The main purpose of this case review is to emphasize the importance of diagnosing iliopsoas hematomas and the possibility of antiplatelet contribution to its development. Case Presentation We are reporting a rare presentation of non-traumatic iliopsoas hematoma in a non-anticoagulated patient. The patient is a 59-year-old male, with known type-2 diabetes, on oral hypoglycemic medications, 3-weeks post-COVID-19. He had started aspirin 81 mg orally, once daily, to prevent thrombotic events associated with COVID 19 infection, with no anticoagulant use and no other medications. He came in through the ED, presenting with two weeks history of progressive right lower limb weakness in which an iliopsoas hematoma diagnosis was confirmed based on radiological investigation. Conclusion The possibility of iliopsoas hematoma should be considered in non-anticoagulated patients with no inherited or acquired coagulation disorders presenting with limb weakness. The link between antiplatelet use in a COVID-19 patient and the development of soft tissue bleeding (e.g., iliopsoas hematoma) must be studied further.
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Tavone AM, Giuga G, Attanasio A, Petroni G, Mauriello S, Cordova F, Marella GL. A Rapid Fatal Outcome of Iliopsoas Hematoma: Clinical and Autopsy Findings. J Investig Med High Impact Case Rep 2022; 10:23247096221111760. [PMID: 35848071 PMCID: PMC9290084 DOI: 10.1177/23247096221111760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A case of massive muscular bleeding of iliopsoas resulting in lethal exsanguination is presented. The intramuscular bleeding occurred spontaneously in an old man with heart failure, presented to the emergency department after the acute onset of shortness of breath, and treated with therapeutic doses of antiplatelets and heparin to prevent thrombosis. On the sixth day of recovery, pain in the left lumbar region develops while there was a decrease in hemoglobin level. Computed tomography (CT) scan revealed a 10 × 3 cm hematoma of the left iliac muscle. The treatment was immediately stopped, but within 6 hours, the death was confirmed. The autopsy revealed that the hematoma, and its increased size since the latest imaging assessment, was the leading cause of death. Particularly in older patients with comorbidity, even in those with clotting parameters in the therapeutic range, the potential for fatal result of iliopsoas muscle bleeding should be considered. Identifying potential patience with increased risk of this complication could be important, especially in pandemic time of COVID-19, when the use of anticoagulant therapy—both for treatment and for prevention of severe disease—has become massive and addressed also to people without previous and specific pathologies.
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Affiliation(s)
| | - Gabriele Giuga
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome (Italy)
| | | | - Giulia Petroni
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome (Italy)
| | - Silvestro Mauriello
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome (Italy)
| | | | - Gian Luca Marella
- Department of Surgical Science, University of Rome ‘Tor Vergata’, Rome (Italy)
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Almazrua IS, Almarshad AY, Binzuman G, Alrabiah AM. Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report. Orthop Res Rev 2020; 12:127-132. [PMID: 33061676 PMCID: PMC7519345 DOI: 10.2147/orr.s272077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Psoas hematoma is an uncommon complication following spinal surgeries. It has been reported in both extreme lateral interbody fusion (XLIF) and posterior spinal fusion with instrumentation. Minimally invasive techniques are gaining popularity in recent years due to the appealing advantages of reduced operative time, blood loss, hospital stay, and faster recovery. Case Presentation We are presenting a case of a 77-year-old male with chronic low back pain, diagnosed to have multilevel degenerative disc disease with central and foraminal disc protrusion at L2-L3, L3-L4, L4-L5 with secondary spinal stenosis, underwent XLIF at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws. On the fourth day post-operatively, the patient had flank pain and dropping hemoglobin with femoral nerve palsy symptoms, a CT scan revealed a large psoas hematoma. Conservative management was decided on; a follow-up CT scan and examination showed complete resolution of the hematoma and femoral nerve recovery. Discussion The approach to iliopsoas hematoma post spinal surgeries remains controversial. Iliopsoas hematoma should be suspected in any patients post spinal surgeries even with delayed presentations. The decision to proceed with either surgical intervention or conservative management depends on multiple factors, including patient hemodynamic status, progression of collection and femoral nerve palsy. Conclusion The exact cause of iliopsoas hematoma post different spinal surgery approaches remains vague. In our opinion, other causes including pre- and post-operative anticoagulants should be investigated. Rushing to drain iliopsoas hematomas in case of femoral nerve palsy might not be the ideal option. Instead, monitoring patient responses to resuscitation and taking a watch and wait approach for femoral nerve palsy might be the proper approach.
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Affiliation(s)
- Ibrahim S Almazrua
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Abdullah Y Almarshad
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Ghadah Binzuman
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Anwar M Alrabiah
- Department of Orthopedic Surgery, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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7
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Tsai YC, Ho SW. Asymmetric Psoas Lines. J Acute Med 2020; 10:48-49. [PMID: 32995155 PMCID: PMC7517887 DOI: 10.6705/j.jacme.202003_10(1).0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/25/2019] [Accepted: 07/08/2019] [Indexed: 06/11/2023]
Affiliation(s)
- Yuan-Chih Tsai
- Chung Shan Medical University Hospital Department of Emergency Medicine Taichung Taiwan
| | - Sai-Wai Ho
- Chung Shan Medical University Hospital Department of Emergency Medicine Taichung Taiwan
- Chung Shan Medical University Department of Emergency Medicine Taichung Taiwan
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8
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Seo JG, Yang JC, Kim TW, Park KH. Intramuscular Hematoma on the Psoas Muscle. Korean J Neurotrauma 2019; 15:234-238. [PMID: 31720283 PMCID: PMC6826083 DOI: 10.13004/kjnt.2019.15.e29] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/03/2019] [Accepted: 09/20/2019] [Indexed: 11/22/2022] Open
Abstract
Intramuscular hematomas on the psoas muscle are rare and usually occur as a result of trauma, iatrogenic etiology during lumbar surgery, rupture of the aortic aneurysm, and hematologic diseases. The incidence of spontaneous psoas muscle hematomas has slowly increased as a result of using anticoagulation and antiplatelet agents. Magnetic resonance (MR) imaging is a more sensitive option compared to computed tomography (CT) when diagnosing a hematoma. Coronal T2-weighted images are more useful. CT imaging is also useful to establish the rapid diagnosis of hematoma. When a prolonged prothrombin time and international normalized ratio and decrease platelet count are noted, psoas muscle hematomas should be considered, if there was no lesion in the spinal canal. Most hematomas resolve spontaneously without clinical complications if the hematoma is not large or it is not compressing the surrounding important structures, irrespective of cause.
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Affiliation(s)
- Jun Gue Seo
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Joo Chul Yang
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Tae Wan Kim
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
| | - Kwan Ho Park
- Department of Neurosurgery, VHS Medical Center, Seoul, Korea
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Ferrando Lacarte I, Clemente Sarasa C, Domingo Sanchez MD, Cánovas Pareja C. [Femoral neuropathy: Haematoma in iliac muscle and a lumbar vertebral fracture]. Rev Esp Geriatr Gerontol 2019; 55:120-122. [PMID: 31353128 DOI: 10.1016/j.regg.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/10/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
75-year-old patient with a history of acenocumarol anticoagulated atrial fibrillation, which shows pain, functional impotence and right lower limb paresthesias after fall. Studies evidenc evertebral fracture L5 and haematoma on right iliac muscle, proceeding to surgical drainage, suspension of acenocumarol, and onset of apixaban. After treatment persisted femoral neuropathy, which not allowed complete functional recovery. DISCUSSION: Femoral neuropathy as possible cause of compressive hematoma over iliopsoas muscle or secundary to lumbar canal stenosis and contact with L4 root. In both of the misit posible to observe weakness of proximal lower limb musculature. Haematoma was suspected due to lower back pain, flank mass and hypovolemia. Handlingis based on the severity of the symptomatology, from conservative to surgical drainage to reduce sequelae and bleeding complications. Apixaban has shown a higher safety profile. Stabilization of lumbar fracture allowed partial functional recovery.
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10
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Aishwariya P, Mohammed T, Ashraf S, Vincenzo DS, Abdulqadir N, Mohamed AY. Spontaneous iliopsoas hematoma in a trasfusion dependent β-thalassemia patient with hypersplenism: a case report. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:107-111. [PMID: 30889163 PMCID: PMC6502161 DOI: 10.23750/abm.v90i1.7943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022]
Abstract
A 27-year-old married man with transfusion dependent β-thalassemia (TDT) complaining low back pain due to a spontaneous iliopsoas hematoma is reported. A magnetic resonance imaging (MRI) confirmed the diagnosis.The patient was managed conservatively. The mechanism of spontaneous iliopsoas hematoma was unclear, although tearing of muscle fibers, unrecognized minor trauma, low platelet count, secondary to hypersplenism, and severe liver iron overload, associated to abnormalities of clotting factors synthesis, were the suspected etiologies. He showed a good response to treatment and was discharged home 11 days later. A new MRI, performed 7 months later, showed a complete resolution of hematoma. Although iliopsoas haematoma is an uncommon complication in patients with TDT, it should be considered in the differential diagnosis of a patient with back pain.
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Affiliation(s)
| | - Talat Mohammed
- Department of Radiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Soliman Ashraf
- Department of Pediatrics, University of Alexandria, Alexandria, Egypt
| | - De Sanctis Vincenzo
- Paediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Nashwan Abdulqadir
- Nurse Research Scientist, Cancer Clinical Trials Unit, NCCCR, Hamad Medical Corporation (HMC), Doha, Qatar
| | - A Yassin Mohamed
- Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, (HMC), Doha, Qatar,Correspondence: Mohamed A Yassin, MD Department of Hematology and MedicalOncology National Center for Cancer Care and Research Hamad Medical Corporation - Doha, Qatar Tel. 55037393 E-mail:
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11
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Okada M, Akimoto T, Kawamata M, Imai T, Hishida E, Kohara M, Miki A, Murakami T, Sugase T, Masuda T, Ono Y, Ueda Y, Saito O, Muto S, Nagata D. Retroperitoneal Bleeding: An Experience During Prophylactic Anticoagulation in a Patient With Nephrotic Syndrome. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2017; 10:1179547617723317. [PMID: 28811743 PMCID: PMC5542073 DOI: 10.1177/1179547617723317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/03/2017] [Indexed: 11/23/2022]
Abstract
The association between nephrotic syndrome (NS) and a hypercoagulable state has been demonstrated. Controlling the blood clotting activity may therefore be attractive for patients with nephrosis in terms of thromboembolism prophylaxis. We herein report a 75-year-old woman with minimal change disease who developed pains in the right back, groin, and thigh because of retroperitoneal bleeding during prophylactic anticoagulation with unfractionated heparin. Although this procedure has not been accepted as the standard of care for patients with nephrosis, pharmacologic prophylaxis may already be practiced empirically, as in the present patient. We believe that our experience highlights the pitfalls of such a management in patients with nephrosis, implying the need for a diagnostic strategy for identifying those patients with NS who can benefit from prophylactic anticoagulation. Several concerns that emerged in this case are also discussed.
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Affiliation(s)
- Mari Okada
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Tetsu Akimoto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Mutsumi Kawamata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Toshimi Imai
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Erika Hishida
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Marina Kohara
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Atsushi Miki
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Takuya Murakami
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Taro Sugase
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Takahiro Masuda
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Yuko Ono
- Department of Diagnostic Pathology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Yoshihiko Ueda
- Department of Diagnostic Pathology, Dokkyo Medical University Koshigaya Hospital, Saitama, Japan
| | - Osamu Saito
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Shigeaki Muto
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
| | - Daisuke Nagata
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Shimotsuke-Shi, Japan
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12
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Spontaneous Iliopsoas Hematoma following Microvascular Free Tissue Transfer. Case Rep Otolaryngol 2017; 2017:7631673. [PMID: 28536664 PMCID: PMC5425841 DOI: 10.1155/2017/7631673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/16/2017] [Indexed: 12/02/2022] Open
Abstract
Spontaneous hematoma within the iliopsoas muscle (SIH) is a rare complication most commonly seen in coagulopathic patients. Often, patients undergoing microvascular free tissue transfer are anticoagulated for anastomotic patency. Here we describe two cases of postoperative SIH following contralateral anterolateral thigh (ALT) free tissue transfer for reconstruction of oncologic head and neck defects. Both patients described hip pain after mobilization and had a corresponding acute blood loss anemia. Diagnosis of SIH was confirmed by CT and both patients were managed conservatively. Given that anticoagulation is a common practice following head and neck free tissue transfer, surgeons should be aware of this potential complication.
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13
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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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14
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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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15
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Affiliation(s)
- Yin-Huie Chen
- Department of Internal Medicine, China Medical University Hospital, China Medical University, Taiwan
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