Disclosures: Kian Nassiri, DO: No financial relationships or conflicts of interest

Case Diagnosis: The patient is a 53-year-old male with left ventricular assist device placed in 2019 on warfarin found to have an iliopsoas hematoma with resulting femoral neuropathy.

Case Description: During acute hospitalization for right ventricular heart failure and renal failure, the patient developed insidious onset right hip pain and weakness. CT imaging of the right lower extremity was unremarkable. On arrival to inpatient rehabilitation, the initial physiatry exam demonstrated weakness of the right hip flexors and knee extensors. Sensory loss and allodynia were noted in the anterior thigh and medial leg. Based on clinical suspicion, a CT abdomen pelvis was ordered to evaluate the full course of the femoral nerve, which confirmed a right iliopsoas hematoma likely causing compression on the nerve. After diagnosis, the rehabilitation team focused on pain management, orthotic interventions, and therapies to stabilize the right knee for transfers, standing, gait, and stairs required for his home discharge plan.

Setting: Stand-alone inpatient rehabilitation hospital.Assessment/

Results: Based on review with the complex cardiology team, procedural intervention was determined to be not favorable due to medical risk. Follow-up imaging demonstrated interval decrease in size of the hematoma. The patient benefited from application of orthotics, pain management, and targeted therapies. Quality indicator scores from therapy evaluations showed marked improvement over the course.

Discussion: Spontaneous iliopsoas hematomas are a rare complication of anticoagulation. Femoral neuropathy results due to femoral nerve compression. CT scan of the abdomen and pelvis is the preferred diagnostic test. Depending on severity and risk, treatment may be conservative or interventional.

Conclusion: Iliopsoas hematomas are a rare complication of anticoagulation which can lead to compressive femoral neuropathy and adversely impact function. This case highlights the importance of physiatrists performing detailed neurologic examinations, recognizing features of iatrogenic complications such as iliopsoas hematomas, collaborating across complex medical teams, and leading rehabilitation teams to restore patients’ function.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/femoral-neuropathy-resulting-from-an-iliopsoas-hematoma-highlighting-the-importance-of-acute-inpatient-rehabilitation-a-case-report/