Spontaneous iliopsoas muscle hematoma in a patient with von Willebrand disease: a case report

Abstract

IntroductionIliopsoas hemorrhage is a serious complication of bleeding disorders that occurs most commonly in patients with hemophilia and less commonly in patients with von Willebrand disease. It causes severe pain, muscle dysfunction and occasionally femoral nerve palsy. We describe the case of a patient with von Willebrand disease type 3 with a large iliopsoas hematoma who was treated with a von Willebrand factor concentrate (Humate-P).Case presentationA 20-year-old Iranian man was referred to our emergency ward because of the gradual onset of right flank pain. He was known to have been diagnosed with von Willebrand disease type 3 at age two years old. Magnetic resonance imaging showed a mass in the right iliopsoas muscle. The diagnosis of iliopsoas hemorrhage and partial femoral nerve palsy was established, and he responded to medical treatment.ConclusionWe report a case of von Willebrand disease type 3 with spontaneous iliopsoas hematoma associated with femoral nerve palsy that was well managed with Humate-P treatment.

Large psoas haematoma and femoral neuropathy in a patient with type 2B von Willebrand's disease

“…Unlike in haemophilia, spontaneous muscular haematomas are exceptional in VWD [2,3] including type 2 VWD. The only case of iliopsoas haematoma reported refers to a type 3 von Willebrand patient [4]. In our patient, the accident was clearly post-traumatic as the pain first occurred during a sport session after a monopodal reception on the left leg with hyperextension of the ankle.…”

A rare case of iliopsoas hematoma in a patient with von Willebrand disease

“…2 Iliopsoas hemorrhage can be encountered in coagulation disorders like hemophilia and vWD; and also in patients who are anticoagulation therapy like warfarin, heparin, and ticlopidine. 3,4 The first-ever case was reported by Tallroth in 1939. 5 However, unlike in hemophilia, muscle hematoma is not common in vWD.…”

“…3,8 However there is a case report by Keikhaei et al which suggests that these hematomas can occur spontaneously too. 4 Patients usually present with complaints of pain in the flank or lower lateral abdomen quadrants which radiates to the ipsilateral hip joint. These patients adapt an anti-pain posture with flexion of hip joint and knee joint and when there is an attempted extension of these joints, there is resistance and pain experienced by the patients.…”

“…The management may vary between a decompression (open surgical or percutaneous route) and a medical approach. 4 Those who advocate the former suggest that a decompression might help in minimizing the neurological deficit. Non-operative management involves factor replacement and complete rest.…”

“…As in hemophilia A, musculoskeletal hemorrhages can occur in vWD type 3. 3,4 Iliopsoas hemorrhage is a significant complication as a delay in treatment can lead to permanent palsy of the femoral nerve.…”