Iliacus Hematoma Presenting As Femoral Nerve Palsy

1Durham Regional Hospital, Durham, NC

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 299

Case Presentation:

A 77‐year‐old white woman with a history of pulmonary embolisms on chronic Coumadin therapy and an elective left hip arthroplasty 3.5 weeks prior to admission presented with progressive numbness on the anterior aspect of her left thigh and severe groin pain radiating to her back. Patient was sent from a local rehabilitation center from which she was not progressing due to the aforementioned complaints. On admission it was found that she had had a minor fall in the rehab facility 2 weeks prior. The original concern was for the back injury and degenerative disk disease. She underwent an MRI of the lumbar spine, which showed T12–L2 disk dissection and bulging with stenosis and nonimpinging stenosis L2–L5. She had a slightly elevated CPK, and a myositis workup was negative. Neurosurgery was consulted and recommended medical management due to comorbid conditions. On hospital night 2, the patient had a fall, and a hematoma was found on her surgical hip. Subsequent MRI of hip and CT scan of pelvis showed a 4.1 × 7.7–cm iliacus hematoma that looked to be subacute in nature. Given the physical findings in discussion with orthopedics and neurosurgery, it was felt that the hematoma likely occurred sometime in the previous postoperative course. Her numbness was from a femoral nerve palsy from compression from the iliacus hematoma. Drainage was not elected, and steroids were started. Serial CTs were to follow the size of the hematoma as an outpatient. She was discharged back to her skilled nursing facility.

Discussion:

Iliacus hematoma is a rare complication from pelvic and orthopedic surgeries and is mostly reported in the orthopedic literature. In the increasing environment of comanagement with surgeons, hospitalists should be aware of the signs, symptoms, and diagnostic and therapeutic options for iliacus hematomas. These hematomas occur spontaneously but can happen postoperatively especially in patients with blood dyscrasias and on blood thinners such as Coumadin. Patients can present with femoral nerve palsies such as ambulation difficulties, anterior thigh numbness and or pain. Imaging includes MRIs to diagnose the hematoma. Treatment includes conservative management with physical therapy, steroids, and serial imaging. If femoral palsies do not improve or if they progress, surgical evacuation can occur. In addition if a discreet hematoma is seen on imaging, immediate surgical evacuation may be performed. If patients are promptly diagnosed within 6 weeks of hematoma most make a successful recovery.

Conclusions:

In the era of comanagement, hospitalists need to have a higher index of suspicion for surgical complications in order to promptly diagnose and treat conditions such as an iliacus hematoma.

Iliacus hematoma as seen on T2 MRI.

To cite this abstract:

O'Donnell C. Iliacus Hematoma Presenting As Femoral Nerve Palsy. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 299. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/iliacus-hematoma-presenting-as-femoral-nerve-palsy/. Accessed November 18, 2019.

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