Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Rome (Italy).
Independent Researcher, Rome, Italy.
J Investig Med High Impact Case Rep. 2022 Jan-Dec;10:23247096221111760. doi: 10.1177/23247096221111760.
A case of massive muscular bleeding of iliopsoas resulting in lethal exsanguination is presented. The intramuscular bleeding occurred spontaneously in an old man with heart failure, presented to the emergency department after the acute onset of shortness of breath, and treated with therapeutic doses of antiplatelets and heparin to prevent thrombosis. On the sixth day of recovery, pain in the left lumbar region develops while there was a decrease in hemoglobin level. Computed tomography (CT) scan revealed a 10 × 3 cm hematoma of the left iliac muscle. The treatment was immediately stopped, but within 6 hours, the death was confirmed. The autopsy revealed that the hematoma, and its increased size since the latest imaging assessment, was the leading cause of death. Particularly in older patients with comorbidity, even in those with clotting parameters in the therapeutic range, the potential for fatal result of iliopsoas muscle bleeding should be considered. Identifying potential patience with increased risk of this complication could be important, especially in pandemic time of COVID-19, when the use of anticoagulant therapy-both for treatment and for prevention of severe disease-has become massive and addressed also to people without previous and specific pathologies.
现报告一例巨大的髂腰肌肌肉出血导致致命性出血的病例。这名老年男性患有心力衰竭，其肌肉内出血为自发性，在急性呼吸困难发作后到急诊科就诊，并接受了抗血小板和肝素的治疗剂量以预防血栓形成。在恢复的第六天，左腰区出现疼痛，同时血红蛋白水平下降。计算机断层扫描（CT）显示左侧髂肌有一个 10×3 厘米的血肿。立即停止治疗，但在 6 小时内，死亡得到确认。尸检显示血肿及其自最新影像学评估以来的增大是导致死亡的主要原因。特别是在有合并症的老年患者中，即使凝血参数在治疗范围内，也应考虑髂腰肌出血导致致命结果的可能性。识别具有这种并发症高风险的潜在患者可能很重要，尤其是在 COVID-19 大流行期间，抗凝治疗的使用——无论是用于治疗还是用于预防严重疾病——已经变得广泛，并且也针对没有先前和特定病理的人群。
