Iliopsoas Hematoma in Warfarin Treatment: Case Report and Review of Literature

Abstract

Iliopsoas hematoma is a rare complication in patients on warfarin and usually presents as lower abdominal, groin or thigh pain. The author presents a case of spontaneous iliopsoas hematoma in an 89-year-old female that was initially suspected to be a hip fracture. A review of 12 case reports on iliopsoas hematoma in patients on warfarin shows that the mean age of reported cases was 72 years. Patients present with lower abdominal, groin, flank or thigh pain (100%), lower extremity weakness and/or difficulty in walking (50%) and loss of or abnormal sensation in the lower extremity (17%). Forty two percent of the hematoma cases were in patients with therapeutic or sub-therapeutic international normalized ratio (INR). Iliopsoas hematoma should be considered in elderly patients on warfarin who present with lower abdominal or groin pain, even in patients with therapeutic or sub-therapeutic INR.