Large Psoas Hematoma Complicating Anti-coagulant Therapy Poses a Diagnostic and Therapeutic Challenge
Brahim Nassour A. *
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Hissein Hagguir
Urology Department, Ibn Rochd University Hospital, Morocco.
Noel Mahoungou
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Harouna Seydou
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Fadoul Adam
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Salim Arous
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Leila Azzouzi
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Abdel Nasser Dirghil
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
Rachida Habbal
Cardiology Department, Ibn Rochd University Hospital, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Spontaneous psoas haematoma in patients on anti-coagulant therapy is a rare phenomenon. It poses a real diagnostic problem and a real therapeutic challenge. We report the case of a 51 year old patient, under anti-vitamin K (acenocoumarone) following a stenosante and tricuspid mitral plasty who presented with right lumbar pain radiating to the lower limb leading to functional impotence. Clinically, he was hemodynamically stable with a hematoma measuring 88x29 mm and extending to 161 mm. The ultrasound scan showed a large collection at the expense of the lumbar psoas muscle and the CT scan showed a swollen appearance of the right psoas muscle in its iliac portion. Management was conservative: discontinuation of anti-vitamin K, bed rest, antibiotic therapy, and monitoring (clinical, biological and radiological). The ultimate outcome was favourable.
Keywords: Heart disease, anti coagulant, anti vitamin K, haematoma, psoas