Acute Femoral Neuropathy Secondary to Iliacus Hematoma

ABSTRACT

A 45-year-old, alcoholic liver cirrhosis patient presented to the Emergency Department(ED) with complaint of acute intense pain and weakness in the right lower extremity without trauma; hip flexor grade 3/5, knee extensor 2/5, and others normal. Initially, emergency physician diagnosed radiculopathy due to high lumbar disc herniation; however, plain a radiograph and an MRI of the lumbar spine did not revealed definitive compression of the nerve root. On the second hospital day at emergency department, swelling, tenderness of anterior proximal thigh and right inguinal pain were detected and computerized tomography (CT) of the abdomen was performed, which revealed diffuse swelling of right iliacus muscle with acute hematoma. Despite extravasation of contrast for CT imaging, the patient was managed conservatively because of improved neurologic deficit and coagulation abnormality of liver cirrhosis. An early correct diagnosis of femoral nerve palsy caused by iliacus hematoma in the ED is unlikely because of its rare incidence and it is difficult for complete history taking during physical examination involving some special case of severe pain such as this case.