Computerized tomographic demonstration of a retroperitoneal hematoma causing femoral neuropathy

Abstract

To the previously reported 28 cases of femoral neuropathy caused by a retroperitoneal hematoma in patients on anticoagulant drugs are added two cases in which the diagnosis was made by direct visualization of hematoma of the iliacus muscle by computerized tomography of the abdomen.

Femoral Nerve Lesion subsequent to Renal Transplantation

“…Whereas ultrason ography may fail to demonstrate a mass located close to the iliac bone, computerized tomography allows direct and clear visualizing of retroperitoneal structures [5]. If iliopsoas hematoma is diagnosed it should be removed immediately by surgical reintervention, since a high per centage of patients with such bleeding have residual disa bility and prolonged recovery time unless decompression neurolysis is performed [1,2,5]. As a prophylactic mea sure, we would advise waiting for normalization of the prothrombin time before grafting, especially in older pa tients with a history of hypertension and vascular dis ease.…”

“…Although it remains unclear whether the hematoma found in our patient was the main cause for femoral neuropathy or a secondary factor leading to further nerve injury and delayed recovery, we suggest that an active search for a hematoma should be started whenever femoral neuropa thy occurs after renal transplantation. Whereas ultrason ography may fail to demonstrate a mass located close to the iliac bone, computerized tomography allows direct and clear visualizing of retroperitoneal structures [5]. If iliopsoas hematoma is diagnosed it should be removed immediately by surgical reintervention, since a high per centage of patients with such bleeding have residual disa bility and prolonged recovery time unless decompression neurolysis is performed [1,2,5].…”

Bilateral Femoral Nerve Compression and Compartment Syndrome Resulting from Influenza A–Induced Rhabdomyolysis: A Case Report

“…16,17 Some authors recommend operative decompression of the haematoma if the patient is fit for surgery. [18][19][20][21][22][23][24] Others advocate conservative management at least initially, [25][26][27] because meta-analyses failed to demonstrate significant differences in outcomes for surgical versus conservative approaches. 28 The decision was even more complicated in our case because there was diffuse iliopsoas swelling, but no localised pathology.…”

Acute Anticoagulant-Induced Compressive Lumbar Plexus Neuropathy

“…1978;Cranberg, 1979;Wallach and Oren, 1979] and may suggest the diagnosis. Conventional ra diographic methods used to document retro peritoneal haemorrhage rely greatly on infer ential signs and lack both sensitivity and specificity and may be inconclusive [Sagel, 1977], However, retroperitoneal haemor rhage can now be documented by CT scan [Simeone et al, 1977;Sagel, 1977;Emery and Ochoa. 1978;Zarranz and Salisachs, 1979].…”