Article Figures & Data
Figures
- Figure 1
- The CT of the pelvis, which demonstrates bilateral psoas hematomas, more significant on the left and right iliac hematoma (transverse plane).
- Figure 2
- The CT of the abdomen and pelvis, which demonstrates bilateral psoas hematomas, more extensive on the left as well as right iliac hematoma (coronal plane).
- Figure 3
-Timeline of patient’s illness and recovery
Tables
- Table 1
- Cases of bilateral femoral neuropathy associated with bilateral Iliopsoas, psoas, or iliacus hematomas reported in the literature*
Author et al./ year Gender/ age Background of the case Hematoma location and size Timing of hematoma Macauley P et al./ 20172 F/64 yr PE and DVT on enoxaparin; history of hypertension, type 2 DM, and COPD Bilateral psoas hematomas larger on the Rt, without extravasation Day 10 of admission for PE/ DVT Basheer A et al./ 20131 F/63 yr PE on IV heparin and a single dose of clopidogrel, followed next day by warfarin with heparin bridging Large, bilateral iliopsoas muscle hematomas Day 7 of presentation with PE Wada Y, Yanagihara C, and Nishimura Y/ 20055 F/85 yr TIA on heparin infusion and warfarin; hypertrophic cardiomyopathy Bilateral iliopsoas hematomas larger on the Rt with seeping of the contrast material into the hematomas After 3 days of heparin and warfarin treatment Jamjoom ZA et al./ 19936 F/19 yr DVT on heparin, with warfarin added 10 days later; history of estrogen and progesterone therapy for menstrual disturbances Two large hematomas in both iliacus muscles; Sizes on US: Lt 19 x 62 mm, Rt 27 x 65 mm After 3 wk of warfarin treatment Chevalier X and Larget-Piet B/ 19927 F/75 yr Myocardial ischemia on heparin; history of MI Giant hematoma of Lt psoas muscle and blood collection in Rt psoas muscle N/A Niakan E et al./ 19918 M/54 yr Acute PE secondary to DVT on heparin and warfarin Bilateral iliopsoas hematoma; Rt larger than Lt. N/A Barontini F and Macucci M/ 19869 M/65 yr Previous MI on antiaggregant therapy (Teklid) and anticoagulant (Calciparina); history of gastrectomy and operation for L4-L5 disc hernia Small hemorrhagic areas of both iliac muscles More than 2.5 yr after starting Teklid and 3 mon after starting Calciparina Storen EJ/ 197810 F/50 yr DVT on heparin infusion, with warfarin added after 3 days Bilateral iliacus hematoma 5 days after starting heparin ↵* The mechanism of hematoma in all cases was anticoagulation. N/A: not available; F: female; M: male, yr: year; wk: week; mon: month; Rt: right; Lt: left; PE: pulmonary embolism; DVT: deep vein thrombosis; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; IV: intravenous; TIA: transient ischemic attack; MI: myocardial infarction; US: ultrasound; MCV: motor conduction velocity; TAE: transcatheter arterial embolization
- Table 1
- Cases of bilateral femoral neuropathy associated with bilateral iliopsoas, psoas, or iliacus hematomas reported in the literature*
Symptoms related to femoral neuropathy Timing of neuropathy presentation Positive examination findings on neuropathy presentation Management Outcome Inability to move bilateral lower extremities Day 16 of admission for PE/ DVT Inability to elevate legs against gravity or to extend knees; absent leg reflexes Conservative management Discharged to a rehabilitation center 4 wk after neuropathy diagnosis with motor strength 4/5 in bilateral lower extremities Moderate weakness in proximal lower extremities Day 7 of hospitalization Strength 3/5 in bilateral iliopsoas and 2/5 in quadriceps; hyperalgesia and numbness over the L2-L4 dermatomes, bilaterally Conservative management followed by surgical decompression At 3- and 6-month follow-up visits, full strength in lower extremities, but continued mild dysesthesias in anterolateral thighs bilaterally Severe pain in anterior aspect of Rt thigh, followed next day by similar, less intense symptoms on Rt side N/A Reduced sensation to pinpricks in the distribution of Rt saphenous nerve; next day bilateral femoral nerve palsy more severe on the Rt than on the Lt Conservative management followed by TAE On discharge, 3 wk after TAE, femoral nerve function had returned to normal apart from a mild residual weakness in Rt quadriceps muscle Numbness of anterior aspect of both thighs with both legs held flexed at hip joints Second day of pain onset Bilateral incomplete femoral nerve palsy, Rt more than Lt Conservative management followed by bilateral surgical decompress-ion On discharge, 3 wk after surgery, femoral nerve functions had returned to normal apart from mild residual weakness in Lt quadriceps muscle Sudden Lt thigh pain, followed by complete deficit of the entire quadriceps Several hours after hematoma symptom onset Quadriceps score of zero and complete abolition of Lt patellar reflex; strength of Rt quadriceps and Rt patellar reflex were also diminished Emergency surgery Poor postoperative recovery; seven months later, Lt quadriceps deficit score retained between 3 and 4, which considerably interfered with walking Paresthesias over anterior aspect of Rt thigh, radiating to medial and anterior portions of lower leg; Rt hip flexed; developed similar, less intense symptoms with on Lt side after 48 hr N/A Weakness of Rt quadriceps femoris; decreased sensation to pinprick in Rt saphenous nerve distribution; knee jerk: Rt 1+ and Lt 2+; ankle jerk: 1+ bilaterally; flexor plantar responses Surgical evacuation of Rt hematoma and conservative management of Lt hematoma All symptoms in both legs resolved within a few days, except for mild paresthesias on the Rt. Pain in lower limbs, followed by inability to get up Around the same time as hematoma presentation Impossibility of extension of legs; remarkable reduction of flexion and adduction of thighs; absent patellar reflexes; hypoesthesia on anterior surface of thighs and middle surface of shins; findings were bilateral, but greater on Lt side Conservative management More than 3 mon after admission, walking was possible without support; motor deficit in lower limbs was 4th degree on Lt and 2nd degree on Rt; sensation in femoral nerve territory was remarkably improved Anesthesia on medial aspect of both thighs 48 hr after hematoma symptom onset Bilateral flaccid paralysis of femoral nerve; absence of patellar reflex bilaterally Immediate operation with bilateral hematoma evacuation; warfarin treatment was maintained At 10 wk after the operation, pt was able to walk unsupported and bend knees to near sitting position; skin sensibility returned to near normal ↵* The mechanism of hematoma in all cases was anticoagulation. N/A: not available; F: female; M: male, yr: year; wk: week; mon: month; Rt: right; Lt: left; PE: pulmonary embolism; DVT: deep vein thrombosis; DM: diabetes mellitus; COPD: chronic obstructive pulmonary disease; IV: intravenous; TIA: transient ischemic attack; MI: myocardial infarction; US: ultrasound; MCV: motor conduction velocity; TAE: transcatheter arterial embolization
