Treatment of Spontaneous Psoas Hematoma in a Hemiplegic Patient Undergoing Anticoagulation Therapy: case report

Spontaneous psoas hematoma in patients receiving anticoagulation therapy is a rare condition, but sometimes very serious even fatal, if not properly treated on time. One of our patients developed large spontaneous psoas hematoma while intensive rehabilitation therapy due to recent stroke with global aphasia and right hemiplegia. He had undergone anticoagulation therapy with warfarin and prothrombin time was within therapeutic range. Patient revealed sudden cold sweating with change of vital sign. Because of global aphasia, he could not explain subjective symptoms, but revealed rebound tenderness in right lower quadrant on physical examination. Emergency abdominal & pelvic CT scan showed large hematoma on right iliopsoas area with retroperitoneal extension. Because of unstable hemodynamics and high risks for surgery, transcatheter arterial emboilzation was recommended. Bleeding was controlled successfully after transcatheter arterial embolization, and vital sign was stabilized without other neurologic change.

A Case of Occult Retroperitoneal Hematoma Associated with Head Trauma

The diagnosis and appropriate management of blunt abdominal trauma including retroperitoneal hematoma associated head injury is difficult. In our case, psoas muscle hematoma was revealed during the evaluation of fever. Psoas muscle hematoma most commonly results secondarily from coagulation defect or from retroperitoneal bleeding into the psoas sheath. The presenting signs and symptoms of this case are hypotension and anemia. Pain is also present in the back or abdomen. If it is associated with head injury and not presented massive hemorrhage, the actual diagnosis is not easy. The appropriate management depends on a careful initial evaluation including suspicion of physician, repetitive physical examination, the timely use of diagnostic procedures.