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Bilateral iliopsoas hematomas complicating anticoagulant therapy
Yuko Wada1, Chie Yanagihara, Yo Nishimura
1Department of Neurology, Nishi-Kobe Medical Center, Kouji-Dai, Kobe.
Internal Medicine (Tokyo, Japan)
|July 16, 2005
Summary
An 85-year-old woman on anticoagulant therapy developed bilateral femoral nerve palsy due to iliopsoas hematomas. This rare case highlights the importance of suspecting iliopsoas hematoma in patients with groin pain.
Area of Science:
- Neurology
- Radiology
- Hematology
Background:
- Anticoagulant therapy is crucial for preventing thromboembolic events like transient ischemic attack (TIA).
- Femoral nerve palsy can arise from various causes, including compression or hematoma formation.
- Iliopsoas hematomas are collections of blood within the iliopsoas muscle, often associated with bleeding disorders or anticoagulation.
Observation:
- An 85-year-old female patient on anticoagulation for TIA presented with sudden onset of bilateral groin and thigh pain.
- Physical examination revealed bilateral femoral nerve palsy.
- Computed Tomography (CT) scan confirmed bilateral iliopsoas muscle hematomas, with the right being larger and causing more pronounced neuropathy.
Findings:
- Despite therapeutic anticoagulant levels, bilateral iliopsoas hematomas occurred, leading to femoral nerve compression.
- The patient's femoral neuropathy, though severe, showed gradual improvement without surgical intervention.
- The bilateral nature of the presentation was clinically exceptional.
Implications:
- Iliopsoas hematoma should be considered in the differential diagnosis of patients on anticoagulant therapy presenting with unexplained groin or thigh pain.
- Prompt radiological imaging (CT scan) is essential for diagnosing iliopsoas hematomas.
- Conservative management may be effective for iliopsoas hematomas causing femoral neuropathy, even in severe cases.