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Sciatic nerve compression during anticoagulation therapy. Computerized tomography aids in diagnosis.

H W Wallach, M E Oren

    Archives of Neurology
    |July 1, 1979
    PubMed
    Summary
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    Anticoagulated patients experiencing hip pain and falling hemoglobin may have gluteal muscle hemorrhage. Computerized tomography confirmed this diagnosis, avoiding invasive procedures and guiding treatment.

    Area of Science:

    • Internal Medicine
    • Radiology

    Background:

    • Anticoagulation therapy with heparin sodium and warfarin sodium is crucial for conditions like femoral vein phlebitis.
    • Managing anticoagulation requires careful monitoring to prevent complications such as bleeding.

    Observation:

    • A patient on anticoagulation therapy developed severe hip pain and a significant drop in hemoglobin.
    • Physical examination revealed tenderness along the sciatic nerve without ecchymoses.
    • Initial suspicion of retroperitoneal hematoma was not confirmed by imaging.

    Findings:

    • Computerized tomography (CT) scan revealed hemorrhage into the gluteal muscles, not the retroperitoneal space.
    • Correction of anticoagulation with protamine sulfate and vitamin K led to pain reduction and hemoglobin stabilization.

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  • CT imaging provided clear visualization of buttock hematomas, obviating the need for invasive diagnostic studies.

    • Implications:

    • Hip pain and falling hemoglobin in anticoagulated patients warrant consideration of bleeding into the gluteal muscles.
    • CT is a valuable non-invasive tool for diagnosing deep tissue hematomas in this clinical context.
    • Prompt diagnosis and management of bleeding complications are essential for patient recovery.