Iliopsoas hematomas in people with hemophilia: diagnosis and treatment

Abstract

ABSTRACT Introduction Iliopsoas muscle hemorrhage in patients with hemophilia is a serious complication with relevant related morbidity. Areas covered A Cochrane Library and PubMed (MEDLINE) search of studies related to iliopsoas hematomas in hemophilia was analyzed. Pain in the hip joint area and femoral nerve involvement in people with hemophilia should alert physicians to the likelihood of a hemorrhage of the iliopsoas muscle. Clinically, reduced hip range of motion and deficient motor and sensory function of the femoral nerve can be found. Imaging studies, such as ultrasonography (US), CT scan, and MRI will confirm the diagnosis. The first-line therapy for iliopsoas hematoma must be conservative (hematological treatment using high-dose replacement therapy until full resorption monitored by means of imaging studies). Related femoral nerve involvement typically resolves with conservative treatment (rehabilitation). Pelvic hemophilic pseudotumors can occur in patients with hemophilia due to recurrent iliopsoas muscle bleeding, often related to late diagnosis and poor hemostasis. Expert opinion Long-term clotting factor replacement is the pillar of the management of iliopsoas hematomas. Percutaneous US-guided aspiration of blood can be performed in hematomas of large size. However, the rate of failed aspirations and hematoma repetition is substantial (13%).