Posthuma Anne G, Hogervorst Mike, van Munster Barbara C
Department of Geriatrics, Gelre Hospitals, Apeldoorn, the Netherlands.
Department of Surgery, Gelre Hospitals, Apeldoorn, the Netherlands.
Int J Surg Case Rep. 2020;73:187-189. doi: 10.1016/j.ijscr.2020.07.003. Epub 2020 Jul 15.
A psoas hematoma is an uncommon condition in patients on anticoagulant therapy and patients with bleeding disorders. It can present itself with non-specific symptoms, as anemia, pain and hemodynamically instability. The CT angioscan is the diagnostic test of choice.
We report a series of 3 cases of iliopsoas hematoma in older patients. These patients were all on anticoagulant therapy and presented with non-specific symptoms as pain in back or groin, anemia and weakness of the leg. These symptoms could be well explained by other, concurrent diseases. Moreover in one case it was not possible to obtain a reliable history due to cognitive impairment of the patient. In our cases the diagnosis of a psoas hematoma was made after performing many diagnostics or found fortuitously. All three patients recovered well after (temporarily) ceasing of anticoagulant therapy.
The diagnosis of a psoas hematoma is difficult, especially in elderly patients as illustrated in these cases. The symptoms of a psoas hematoma are often aspecific and can also be explained by other, comorbid diseases. Moreover, elderly patients often have an unusual presentation of illness and the presence of cognitive impairment compromises the reliability of a patients history. It is important to be aware of this diagnosis and perform a CT-scan when a psoas hematoma is possible.
A psoas hematoma is easily overlooked in older patients due to an unusual presentation of illness, comorbidity and cognitive impairment.
腰大肌血肿在接受抗凝治疗的患者和有出血性疾病的患者中是一种罕见病症。它可能表现为非特异性症状，如贫血、疼痛和血流动力学不稳定。CT血管造影扫描是首选的诊断检查。
我们报告了一系列3例老年患者的髂腰肌血肿病例。这些患者均接受抗凝治疗，表现为背部或腹股沟疼痛、贫血和腿部无力等非特异性症状。这些症状可能由其他并发疾病很好地解释。此外，在1例病例中，由于患者存在认知障碍，无法获得可靠的病史。在我们的病例中，腰大肌血肿的诊断是在进行了多项诊断后或偶然发现的。所有3例患者在（暂时）停止抗凝治疗后恢复良好。
腰大肌血肿的诊断很困难，尤其是在老年患者中，如这些病例所示。腰大肌血肿的症状通常是非特异性的，也可能由其他合并疾病解释。此外，老年患者的疾病表现往往不寻常，认知障碍的存在会影响患者病史的可靠性。当可能存在腰大肌血肿时，意识到这一诊断并进行CT扫描很重要。
由于疾病表现不寻常、合并症和认知障碍，腰大肌血肿在老年患者中很容易被忽视。
