Masaki Shoichi, Takahashi Tadashi, Sahara Toshinori, Endo Ryo, Obana Masayoshi
Department of Rehabilitation Medicine, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Department of Rehabilitation Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan.
Prog Rehabil Med. 2022 Feb 4;7:20220004. doi: 10.2490/prm.20220004. eCollection 2022.
COVID-19 is associated with an increased risk of venous thromboembolism (VTE), and prophylactic anticoagulation is recommended for the prevention of VTE in COVID-19 patients. We encountered a patient with COVID-19 who developed iliopsoas hematoma (IPH) that was likely caused by prophylactic anticoagulation against VTE; we report the case here because IPH is an important risk in rehabilitation treatment.
The patient was a 73-year-old man with severe COVID-19 who received anticoagulation therapy from the time of admission (day 0). On day 22, decreased hemoglobin levels, muscle weakness in the left lower extremity, and pain on passive movement of the left hip joint were noted. On day 29, computed tomography (CT) was performed and revealed a mass lesion suspicious of a hematoma in the left iliopsoas muscle. On day 36, magnetic resonance imaging (MRI) was carried out to re-evaluate the mass lesion and revealed a multicystic lesion that could also have been an abscess. CT-guided puncture drainage was performed, but no pus-like material was collected; this finding led to a diagnosis of IPH. Subsequent exercise loads were gradually increased while the status of the hematoma was assessed.
The prevalence of IPH in COVID-19 patients has been reported to be 7.6 cases per 1000 admissions, and the use of anticoagulation is likely to increase the risk of IPH. Because rehabilitative interventions can lead to the discovery or aggravation of IPH, the possibility of IPH should be kept in mind when providing rehabilitation treatment for COVID-19 patients.
新型冠状病毒肺炎（COVID-19）与静脉血栓栓塞症（VTE）风险增加相关，推荐对COVID-19患者进行预防性抗凝以预防VTE。我们遇到一名COVID-19患者，发生了可能由预防性抗凝VTE导致的髂腰肌血肿（IPH）；我们在此报告该病例，因为IPH是康复治疗中的一个重要风险。
该患者为一名73岁男性，患有重症COVID-19，自入院时（第0天）开始接受抗凝治疗。在第22天，发现血红蛋白水平下降、左下肢肌肉无力以及左髋关节被动活动时疼痛。在第29天，进行了计算机断层扫描（CT），显示左髂腰肌有一个可疑血肿的肿块病变。在第36天，进行了磁共振成像（MRI）以重新评估肿块病变，显示为多囊性病变，也可能是脓肿。进行了CT引导下穿刺引流，但未收集到脓性物质；这一发现导致诊断为IPH。随后在评估血肿状态的同时逐渐增加运动负荷。
据报道，COVID-19患者中IPH的患病率为每1000例入院患者中有7.6例，使用抗凝剂可能会增加IPH的风险。由于康复干预可能导致IPH的发现或加重，在为COVID-19患者提供康复治疗时应牢记IPH的可能性。
