Femoral Nerve Compression Secondary to Spontaneous Iliacus Muscle Haematoma in a Patient on Anticoagulant therapy: A Case Report

Abstract

Uncommon spontaneous haematomas of the iliacus muscle are observed in patients on anticoagulant medication or in those with blood dyscrasias like haemophilia. Femoral neuropathy, which may involve pain and paralysis, can arise as a result of these haematomas. Delays in the evacuation of haematomas can lead to protracted or irreversible impairment, as therapeutic options for femoral nerve involvement are not well established. The case discussed in this report is an unusual instance of a spontaneous haematoma of the iliacus muscle in a 67-year-old female patient, who presented with left lower limb pain, swelling, and weakness. She had a history of long-term Warfarin use for cardiac prosthetic valve replacement. An ultrasonography and doppler study of the affected region quickly revealed the concerning presence of an iliacus haematoma causing femoral nerve compression. Further Computed Tomography (CT) imaging illustrated the extent of the haematoma, which ultimately required drainage. Following the drainage of the haematoma and relief of compression on the femoral nerve, the patient showed dramatic improvement in her presenting complaints. This report highlights the need for a high level of clinical acumen and suspicion for spontaneous bleeding episodes with atypical or unusual presentations in patients on Warfarin therapy. Furthermore, the case underscores the importance of rapid ultrasonographical evaluation of the involved region and subsequent non surgical intervention for drainage.

Keywords

• neuropathy
• pigtail drain
• prosthetic valve
• warfarin