Successful Transcatheter Arterial Embolisation for a Traumatic Iliacus Hematoma: A Case Report

@#A traumatic iliacus hematoma is rare and usually occurs in patients after a fall involving a lower back injury. Although the hematoma may compress the femoral nerve causing femoral nerve palsy, the gold standard treatment for this condition has not been established. Here we report transcatheter arterial embolisation as a useful treatment strategy for a traumatic iliacus hematoma.

Non-operative Treatment of Femoral Neuropathy Caused by Iliacus Hematoma: A Case Report / 대한고관절학회지

Treatment of femoral neuropathy caused by iliacus hematoma can be divided according to operative treatment and non-operative treatment. Recently, percutaneous drainage has been more popular because it is relatively simple, convenient, and less invasive. After warfarin overuse, a 71-year-old male patient visited the emergency room with femoral neuropathy caused by a left iliacus muscle hematoma measuring approximately 110x64 mm, 75x60 mm in size on coronal and sagittal computed tomography angiograhy. Without trauma, weakness of the left hip flexor and left knee extensor was noted with strength of 2/5 (poor) each. Immediate medical treatment using vitamin K and fresh frozen plasma was started and percutaneous drainage was performed. Two days after visiting the emergency room, neurological symptoms were improved and non-operative treatment was continued. Twenty four days after being hospitalized, the size of the hematoma was reduced to approximately 75x45 mm, 62x40 mm in size. Approximately three months after hospitalization, most of the hematoma was absorbed. After one year, mild atrphy of quadriceps and mild diffuse pain were noted, however, no other symptoms were observed.

Femoral Neuropathy and Meralgia Paresthetica Secondary to an Iliacus Hematoma

Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9x5x4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.