Iliacus Hematoma Research Articles

Abnormal Lower Extremity Movements in a Term Infant.

Abnormal Lower Extremity Movements in a Term Infant.

Adolescent Male with Severe Groin Pain Due to Traumatic Injury.

Case PresentationA 14-year-old boy presented to the emergency department complaining of severe groin pain on the right side following a minor fall. Computed tomography and magnetic resonance imaging revealed a hematoma in his right iliacus muscle. He was diagnosed with a traumatic iliacus hematoma, and he recovered spontaneously with short-term oral analgesics.DiscussionTraumatic iliacus hematomas are rare entities and subside with conservative management in most cases. However, this condition may be associated with femoral nerve palsy, and surgery is indicated in severe cases. Traumatic iliacus hematoma should be considered in the differential diagnosis of severe groin pain.

Iliacus hematoma syndrome: A systematic review of recent literature and case report

BackgroundFemoral nerve palsy caused by iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. However, due to potentially devastating outcomes, prompt recognition and management are essential. ObjectivesThe aim with this study was to better characterize clinical presentation, diagnosis, treatment, and prognosis of iliacus hematoma. MethodsWe performed a systematic review of recent literature regarding femoral neuropathy secondary to an iliacus hematoma. A structured literature review of multiple databases ((PubMed, Web of Science, EMBASE, and Cochrane library) referenced articles from 2000 to 2019. ResultsA total of 25 patients from 25 published studies were identified. The average age of the patients was forty years (range, 12 to 85 years). There were 16 male patients and 9 female patients. The single most important predisposing cause of iliacus hematoma was trauma (14/25), with a pooled percentage of 56%. All patients with spontaneous hematoma were taking antiplatelet medications. Thirteen patients (52%) were treated conservatively with analgesia. Surgical decompression was performed in 10 patients (40%). At the final follow-up, complete resolution of symptoms was achieved in 12 patients (48%). ConclusionsAlthough rare, iliacus hematoma syndrome carries significant morbidity. Spontaneous iliacus muscle hematoma should be considered in the differential diagnosis of leg pain in a patient who is on anticoagulation therapy. In patients with an iliacus hematoma and neurology deficit, conservative treatment can be considered initially if there is no progression in the symptoms evident at the time of presentation. However, prompt surgical decompression has been highly recommended in patients with progressive neurological deficits

Silent subperiosteal iliac hematoma with bone radiolucency in adolescent male athletes

BackgroundSubperiosteal hematoma of the iliac bone is reported as a rare disorder that specifically occurs in young patients after obvious trauma. This report presents seven cases of male adolescent athletes with subperiosteal iliac hematoma without blunt trauma that was identified as an incidental radiolucent lesion on the iliac bone mimicking neoplasm. The purpose of this report is to describe clinical features and radiological findings of silent subperiosteal hematoma of the iliac bone. Subjects and methodsWe retrospectively reviewed the clinical data and radiological appearance of 7 patients who presented with subperiosteal hematoma of iliac bone. ResultsAll seven patients had no obvious trauma and no serious symptoms. All patients were middle school or high school male students who regularly participated in vigorous sports activity; five soccer players, one baseball catcher, and one basketball player. The X-ray showed radiolucent lesion on the iliac bone. Lens-shaped mass without involvement of psoas muscle with ghost native cortex sign and overlying periosteal calcification on CT scan was characteristic radiological finding on subperiosteal iliac hematoma. ConclusionSubperiosteal iliac hematomas can be caused by vigorous sports activity in adolescence. This condition is not always associated with serious symptom. It can be identified as a radiolucent lesion mimicking a neoplasm.

A difficult situation \u2013 balancing critical anticoagulation versus the risk of permanent neurologic deficit: a case report

BackgroundAnticoagulation is the mainstay of treatment for pulmonary embolism. However, if bleeding unfortunately occurs, the risks and benefits of anticoagulation present a challenge. Management of one hemorrhagic complication, retroperitoneal hematoma, is rare, difficult, and controversial.Case presentationA 73-year-old white man presented with left lower extremity swelling and dyspnea. He was tachycardic, hypertensive, and demonstrated poor oxygen saturation of 81% on ambient air. A computed tomography angiogram revealed a saddle pulmonary embolus. Tissue plasminogen activator was administered and he was started on a heparin infusion. He was eventually transitioned to enoxaparin. On the day of discharge, however, he had sudden onset of right leg numbness and weakness below his hip. A computed tomography of his head was not concerning for stroke, and neurology was consulted. Neurology was concerned for spinal cord infarction versus hematoma and recommended magnetic resonance imaging of his thoracic and lumbar spine. The magnetic resonance imaging revealed a left psoas hematoma. A computed tomography scan of his pelvis also showed a right psoas and iliacus hematoma. He was transitioned to a low intensity heparin infusion. The following day his left leg exhibited similar symptoms. There was concern of progressive and irreversible nerve damage due to compression if the hematomas were not drained. Interventional radiology was consulted for drainage. The heparin infusion was paused, drainage was performed, and the heparin infusion was reinitiated 6 hours following the procedure by interventional radiology. His blood counts and neurologic examination stabilized and eventually improved. He was discharged home on a novel anticoagulant.ConclusionsManagement of a retroperitoneal hematoma can commence with recognition of the warning signs of bleeding and neurological impairment, and consulting the appropriate services in case the need for intervention arises. A conservative approach of volume resuscitation and blood transfusion can be used initially, with the need for pausing or reversing anticoagulation being assessed on an individual basis with expert consultation. If intervention becomes necessary, other interventional radiology-based modalities can be used to identify and stop the bleeding source, and interventional radiology-guided drainage can be performed to decrease the hematoma burden and relieve neurological symptoms.

Femoral nerve palsy due to Iliopsoas hematoma

Femoral nerve palsy seconder to iliacus hematoma has been rarely reported in terms of blood coagulation abnormalities, either from anticoagulant medications or from hemophilia. The clinical symptoms vary from femoral neuropathy to fatal hypovolemic shock with increased used of anticoagulant agents; femoral nerve palsy subsequent to hemorrhage within the iliopsoas muscle has become a frequent clinical problem. In our case, a 73-year-old male patient presented to hospital with left leg pain and weakness. Lumbar magnetic resonance imaging (MRI) and abdomen computed tomography (CT) showed a left-sided iliopsoas hematoma. An extraperitoneal inguinal incision (Gibson incision) was made. The hematoma was superior of the external iliac artery in the iliopsoas muscle. It was nearly 8 cm deep and was drained and evacuated. After the operation, the left leg pain decreased, and the weakness of left leg improved (3/5).

Oral Anticoagulation-induced Iliacus Hematoma and Femoral Neuropathy!

Oral anticoagulation is very effective in the management of thrombotic disorders. However, it can be associated with significant bleeding complication as its side effects. Iliacus hematoma presenting as a femoral neuropathy is a rare clinical scenario. Patients on anticoagulation with iliacus hematoma and neurological dysfunction should be taken up for decompression to avoid permanent disability. We, hereby, we report an interesting case of progressive femoral neuropathy due to iliacus hematoma which was decompressed successfully with prompt recovery of neurological dysfunction.

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

혈종의 압박으로 인한 대퇴신경병증의 치료는 수술적 치료와 비수술적 치료로 나누어 볼 수 있다. 최근에는 비교적 간단하고 편리하며 비침습적인 도관을 이용한 경피적 배액술이 애용되고 있다. 본 증례는 장골근 혈종으로 인한 대퇴신경마비의 비수술적 치료에 대해 보고하고자 한다. 71세 남자 환자로 와파린 과다복용 후 컴퓨터 단층촬영의 관상면상 110×64 mm, 시상면상 75×60 mm 크기의 좌측 장골근 혈종으로 인해 대퇴신경병증이 나타났다. 특별한 외상의 기왕력은 없었으며 도수 근력검사에서 좌측 고관절의 굴곡과 슬관절의 신전이 각각 2단계(poor)로 약화되어 있었다. 신선동결혈장과 비타민 K 5 mg을 투여하여 prothrombin time international normal range (INR)을 교정하였고 입원 2일째부터 신경학적 증상이 완화되어 비수술적 치료를 지속하였다. 입원 24일째 컴퓨터 단층 촬영 추시 결과 혈종의 크기는 관상면상 75×45 mm, 시상면상 62×40 mm 크기로 감소하였고, 약 3개월 뒤에는 혈종이 대부분 흡수되었다. 1년 후, 최종 추시 상 대퇴사두근의 경한 위축과 경한 미만성 통증이 있었으나 다른 증상은 관찰되지 않았다.

Complete Femoral Nerve Palsy Following Traumatic Iliacus Hematoma: A Case Report and Literature Review.

Femoral nerve palsy due to iliacus hematoma has been reported previously1-4. Its incidence has increased because of the widespread use of anticoagulants and revision hip surgery. Surgical hematoma evacuation has been highly recommended in patients with coagulopathy5. In healthy patients with posttraumatic iliacus hematoma, previous case reports have revealed excellent results with conservative and surgical treatment for incomplete lesions4,6-11. This report describes the management of a case of complete femoral nerve palsy secondary to traumatic iliacus hematoma in a young patient. The patient and his parents were informed that data concerning the case would be submitted for publication, and they provided consent. A fourteen-year-old healthy boy presented with an eleven-day history of pain and weakness in the right lower limb. He had developed these symptoms after a fall while jumping and somersaulting during a basketball game. The pain in the right thigh and knee had begun four hours after the incident while he was walking. That same night, he found that he could not stand from a sitting position because of progressive pain and weakness in the injured limb. On the next day, he sought medical help with the chief symptom of pain in the right knee and sacrum. Because radiographs of the sacrum and pelvis revealed normal findings, the patient was prescribed nonsteroidal anti-inflammatory medication and discharged. Ten days later, the patient again sought help for persistent right knee pain, swelling, and lower-limb weakness. He entered the outpatient department with the aid of a wheelchair and could walk only with crutches. He had not experienced back pain or lower-extremity weakness prior to this episode. Physical examination revealed tenderness of the right thigh and patellar tendon, mild swelling of the medial aspect of the right thigh, and numbness …

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, 9×5×4.5 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.

Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology

The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults.

Iliac Hematoma Mimicking Neoplasm in Adolescent Athletes

Traumatic injuries of the hip and pelvis are common in child athletes and typically require minimal treatment. However, the presentation of such injuries can at times be clinically indistinguishable from the onset of a benign or malignant neoplastic process. In these circumstances, the orthopedic surgeon relies on modern diagnostic tools including imaging-predominantly magnetic resonance imaging (MRI) and computed tomography-and pathology studies. This article presents the cases of 2 adolescent boys with traumatic injuries to the hip, in which the threat of neoplasm could not be ruled out by in both initial imaging studies. In one case, biopsy could not conclusively rule out malignancy. In both cases, serial MRIs to monitor changes in lesion size proved valuable in determining treatment approach. The authors recommend a diagnostic algorithm to approach the differentiation of iliac hematoma from neoplasm and address the issue of waiting time in the diagnostic process. Early-and if necessary repeated-biopsy to rule out these conditions is advised, as conclusive pathologic findings are the only evidence that can rule out Ewing's sarcoma or an aneurysmal bone cyst. Given the morbidity of these conditions, the authors advocate this course of action to minimize distress to the patient and family members. Careful observation in combination with radiographic findings can yield a successful diagnosis, but the orthopedic surgeon must carefully weigh the increased risk of tumor growth against the need for biopsy.

Non-operative management of femoral neuropathy secondary to a traumatic iliacus haematoma in an adolescent

Iliacus haematoma is a relatively rare condition, which may cause a local compressive neuropathy. It is usually diagnosed in adults with haemophilia or those on anticoagulation treatment and may occur after trauma. We present the case of a healthy 15-year-old boy with a femoral neuropathy due to an iliacus haematoma which resolved following conservative treatment.

Femoral Nerve Palsy Associated with Iliacus Hematoma Following Pseudoaneurysm After Revision Hip Arthroplasty

Iliacus hematoma associated with femoral nerve palsy is a very rare but considerable complication of hip arthroplasty. A 76-year-old woman had femoral nerve palsy 6 months after revision hip arthroplasty using a reinforcement plate. Computed tomography and selective angiography revealed the pseudoaneurysm on an extension of one of the screws fixing the hardware. Transcatheter arterial embolization proximal to the aneurysm was performed to resolve the aneurysm and to prevent further bleeding. Surgical removal of the hematoma was successfully achieved, as was full functional recovery. This case report describes our diagnosis and treatment of this rare condition and also the therapeutic usefulness of the radiologic intervention to control further bleeding before and after surgical removal of the hematoma.

Femoral Nerve Palsy Following Iliacus Hematoma

We report a rare case of femoral nerve palsy secondary to hematoma compression of the iliacus. The patient presented with pain 2 days after performing a double kick in karate. The femoral nerve symptoms (numbness and weakness) did not begin until 3 to 4 days after the initial trauma. Magnetic resonance imaging (MRI) confirmed that there was a hematoma compressing the iliacus (and femoral nerve). This hematoma was subperiosteal, within the iliac fossa. This case is rare because the femoral nerve palsy resolved without surgical intervention, the mechanism of injury, the imaging used to diagnose the iliacus hematoma, and the hematoma was subperiosteal and not within the actual iliacus muscle. A review of the literature regarding femoral nerve palsy secondary to traumatic iliacus hematoma is presented. If the diagnosis of femoral nerve palsy secondary to iliacus hematoma is suspected after history and physical examination, MRI is the imaging study of choice. If MRI does not depict a discreet hematoma mass, nonoperative management should be considered. Electromyography has not been shown to offer information that was not provided by history, physical examination, and other imaging. Surgery should be considered if there is progression of the femoral nerve symptoms, or if MRI depicts a discreet collection of blood impinging on the femoral nerve.

Femoral nerve palsy due to iliacus hematoma occurred after primary total hip arthroplasty

The perforation of the medial acetabular wall during total hip arthroplasty due to drilling is not uncommon. But, it has rarely been associated with serious adverse events. Here, we present a case report describing an iliacus hematoma with subsequent femoral nerve palsy after primary total hip arthroplasty in a 67-year-old woman who underwent primary total hip arthroplasty due to painful hip osteoarthritis. The diagnosis was made by pelvic magnetic resonance imaging. Conservative treatment was employed and the symptoms were resolved within 3 months. It should be borne in mind that femoral nerve palsy may occur after total hip arthroplasty. It may be due to a treatable cause, such as iliacus hematoma. So, pelvic MRI is recommended in such a condition, rather than just observation.

Femoral nerve palsy after mandibular reconstruction with microvascular iliac flap: a complication under anticoagulation therapy

Pharmacological prophylaxis and intervention are used extensively in head and neck reconstructions with microvascular flaps. There is no universally accepted protocol, but the microvascular surgery literature recommends intraoperative anticoagulation with heparin. Here is reported a case of iliacus haematoma with subsequent femoral nerve palsy after the harvest of a microvascular iliac flap for mandibular reconstruction in a patient who had been treated with heparin. The association between femoral nerve palsy and anticoagulant therapy has been well described. It remains unclear as to why the iliacus muscle is particularly vulnerable to intramuscular haemorrhage. Femoral nerve neuropathy is also an uncommon but recognized complication after abdominopelvic surgery. Iliacus haematoma secondary to microvascular surgery has not been previously reported. This case illustrates the need to be aware of this type of complication and its clinical manifestations for patients under anticoagulant therapy in the perioperative period during microvascular reconstructions.

Femoral nerve palsy secondary to traumatic pseudoaneurysm and iliacus hematoma

The authors report a case of traumatic femoral nerve palsy caused by a pseudoaneurysm of the iliolumbar artery and a iliacus muscle hematoma. This case report details not only the classic history and physical findings seen in patients such as this one, but also illustrates an unusual source of the hematoma and a discussion of its treatment. A 20-year-old man was assaulted and presented to the authors's institution with a 1-week history of severe pain in the left anterior thigh and groin, weakness in the left quadriceps muscle, and numbness in the anterior thigh and medial distal leg. Imaging studies demonstrated a large, 9.4 x 6.4 x 5.2-cm iliacus hematoma as well as a pseudoaneurysm originating from the left iliolumbar artery. The patient underwent angiographic embolization of the pseudoaneurysm followed by surgical evacuation of the hematoma. The embolization was performed before surgery to prevent any possible rebleeding from the pseudoaneurysm during evacuation of the hematoma. Femoral nerve palsy caused by traumatic iliacus hematoma is an infrequent diagnosis often missed because of its insidious presentation. In this case, embolization of the iliolumbar artery pseudoaneurysm followed by surgical evacuation of the hematoma resulted in a nearly full recovery of the femoral nerve as of the last follow-up examination.

Total laparoscopic infrarenal aortic aneurysm repair: Preliminary results

We describe our initial experience of total laparoscopic abdominal aortic aneurysm (AAA) repair. Between February 2002 and September 2003, we performed 30 total laparoscopic AAA repairs in 27 men and 3 women. Median age was 71.5 years (range, 46-85 years). Median aneurysm size was 51.5 mm (range, 30-79 mm). American Society of Anesthesiologists class of patients was II, III and IV in 10, 19, and 1 cases, respectively. We performed total laparoscopic endoaneurysmorrhaphy and aneurysm exclusion in 27 and 3 patients, respectively. We used the laparoscopic transperitoneal left retrocolic approach in 27 patients. We operated on 2 patients via a tranperitoneal left retrorenal approach and 1 patient via a retroperitoneoscopic approach. We implanted tube grafts and bifurcated grafts in 11 and 19 patients, respectively. Two minilaparotomies were performed. In 1 case, exposure via a retroperitoneal approach was difficult and, in another case, distal aorta was extremely calcified. Median operative time was 290 minutes (range, 160-420 minutes). Median aortic clamping time was 78 minutes (range, 35-230 minutes). Median blood loss was 1680 cc (range, 300-6900 cc). In our early experience, 2 patients died of myocardial infarction. Ten major nonlethal postoperative complications were observed in 8 patients: 4 transcient renal insufficiencies, 2 cases of lung atelectasis, 1 bowel obstruction, 1 spleen rupture, 1 external iliac artery dissection, and 1 iliac hematoma. Others patients had an excellent recovery with rapid return to general diet and ambulation. Median hospital stay was 9 days (range, 8-37 days). With a median follow-up of 12 months (range, 0.5-20 months), patients had a complete recovery and all grafts were patent. These preliminary results show that total laparoscopic AAA repair is feasible and worthwhile for patients once the learning curve is overcome. However, prior training and experience in laparoscopic aortic surgery are needed to perform total laparoscopic AAA repair. Despite these encouraging results, a greater experience and further evaluation are required to ensure the real benefit of this technique compared with open AAA repair.

Complete paralysis of the quadriceps muscle caused by traumatic iliacus hematoma: a case report

AbstractA 15-year-old girl who developed traumatic iliacus hematoma and complete paralysis of the quadriceps muscle is reported. The current case and literature review revealed that incomplete quadriceps paralysis associated with traumatic iliacus hematoma is likely to progress to complete paralysis in days or weeks as a result of increased intracompartmental pressure. However, surgical decompression of the femoral nerve could produce good results even in patients who have complete quadriceps paralysis preoperatively.