Quan Zhenglin, Zeng Huanchao, Yi Xianfu, Li Changsheng, Fang Zhicheng, Yang Xianyi
Department of Emergency, Taihe Hospital, Jinzhou Medical University Union Training Base, Shiyan, Hubei, China (mainland).
Department of Emergency, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei, China (mainland).
Am J Case Rep. 2021 Sep 24;22:e933322. doi: 10.12659/AJCR.933322.
BACKGROUND Carbon monoxide poisoning is a common reason for Emergency Department admissions worldwide. The symptoms of carbon monoxide poisoning vary from headache and dizziness to severe neuropsychological and cardiac impairment. However, psoas major and iliopsoas hematomas are a rare complication of carbon monoxide poisoning. CASE REPORT A 46-year-old man with carbon monoxide poisoning, after he had been exposed to burning coal without proper ventilation, presented with right low back pain on day 7 after onset. After 2 days, ecchymosis of the right flank occurred, and his hemoglobin concentration gradually decreased. Psoas major and iliopsoas hematomas were shown on computed tomography (CT). The hematomas were successfully treated with transfusions and physical therapy. Owing to the absence of skeletal muscle compartment syndrome, surgical decompression was unnecessary. The patient did not receive anticoagulant therapy during his hospitalization. CONCLUSIONS The direct toxicity of carbon monoxide on the muscles and body weight-induced muscle compression caused skeletal muscle ischemia and necrosis in our patient. The risk of rhabdomyolysis and coagulation abnormality was elevated. Finally, intramuscular hemorrhages occurred in our patient. When a patient has back pain and decreased hemoglobin levels, clinicians should consider the possibility of psoas major and iliopsoas hematomas, and the administration of anticoagulation should be used with caution after admission.
一氧化碳中毒是全球急诊入院的常见原因。一氧化碳中毒的症状从头痛、头晕到严重的神经心理和心脏损害不等。然而，腰大肌和髂腰肌血肿是一氧化碳中毒的罕见并发症。病例报告：一名46岁的男性因一氧化碳中毒，在接触燃烧的煤炭且通风不良后，发病第7天出现右下腹疼痛。2天后，右侧腹部出现瘀斑，血红蛋白浓度逐渐下降。计算机断层扫描（CT）显示腰大肌和髂腰肌血肿。通过输血和物理治疗成功治疗了血肿。由于没有骨骼肌间隔综合征，无需进行手术减压。患者住院期间未接受抗凝治疗。结论：一氧化碳对肌肉的直接毒性以及体重导致的肌肉压迫致使我们的患者骨骼肌缺血坏死。横纹肌溶解和凝血异常的风险升高。最终，我们的患者出现了肌肉内出血。当患者出现背痛且血红蛋白水平下降时，临床医生应考虑腰大肌和髂腰肌血肿的可能性，入院后应谨慎使用抗凝治疗。
