Ohta Soichi, Takahashi Kohei, Iwashita Masayuki, Abe Takeru, Takeuchi Ichiro
Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, JPN.
Cureus. 2022 Feb 24;14(2):e22571. doi: 10.7759/cureus.22571. eCollection 2022 Feb.
In coronavirus disease 2019 (COVID-19), veno-venous extracorporeal membrane oxygenation (VV-ECMO) is used to manage respiratory distress. This study's key clinical question was whether COVID-19 could be complicated by hemorrhagic and thrombotic events, such as iliopsoas hematoma (IPH), during the management of ECMO and the method to quickly and effectively detect IPH. A 52-year-old man with fever and dyspnea was diagnosed with COVID-19 pneumonia. He warranted VV-ECMO management on day 9, which was successfully tapered off on day 18. On day 20, computed tomography revealed a unilateral iliopsoas hematoma that was successfully managed with conservative care. However, a retrospective review of abdominal radiography performed on day 14 revealed a positive left psoas sign. When managing severe COVID-19 patients with VV-ECMO, cautious anticoagulative care and abdominal X-ray findings are warranted when considering the diagnosis of iliopsoas hematoma, including circulatory instability, anemia, and pain associated with limb movement.
在2019冠状病毒病（COVID-19）中，静脉-静脉体外膜肺氧合（VV-ECMO）用于治疗呼吸窘迫。本研究的关键临床问题是，在ECMO治疗期间，COVID-19是否会并发出血和血栓形成事件，如髂腰肌血肿（IPH），以及快速有效检测IPH的方法。一名52岁发热、呼吸困难男性被诊断为COVID-19肺炎。他在第9天需要VV-ECMO治疗，并于第18天成功撤机。第20天，计算机断层扫描显示单侧髂腰肌血肿，经保守治疗成功处理。然而，回顾第14天进行的腹部X线检查发现左侧腰大肌征阳性。在使用VV-ECMO治疗重症COVID-19患者时，在考虑诊断髂腰肌血肿时，包括循环不稳定、贫血以及与肢体活动相关的疼痛，需要谨慎的抗凝治疗和腹部X线检查结果。
