Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients

Abstract

Introduction Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment. Materials and methods We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy. Results Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis. Conclusions Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.

Rare findings of spontaneous hemothorax and small subpleural lung hematoma in a COVID-19 patient: A case report

“…4,5 Some cases of spontaneous hematomas involving the iliopsoas muscle, neck, abdominal wall, and chest wall have also been reported. [13][14][15] The risk of bleeding is relatively high in COVID-19 patients, especially in those who have received therapeutic anticoagulation treatment, and this condition is usually associated with an increased risk of mortality. 16 However, Mattioli et al 4 reported a case of neck and upper chest spontaneous hematoma in an 84-year-old patient who was receiving prophylactic doses of LMWH.…”

“… 4 , 5 Some cases of spontaneous hematomas involving the iliopsoas muscle, neck, abdominal wall, and chest wall have also been reported. 13 – 15 …”

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

“…5, performed according to PRISMA criteria, 21 17 studies were included in qualitative and quantitative syntheses. 16,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] The systematic review identified 40 patients with COVID-19 complicated by muscular hematomas.…”

COVID-19 and the Kidney: A Worrisome Scenario of Acute and Chronic Consequences

“…The bleeding risk of each individual patient needs to be considered prior and during the implementation of any of these strategies given that anticoagulation, especially when systemic, may increase the propensity for bleeding. A case series from Italy, for example, described the case of seven patients admitted to the hospital with COVID-19 who presented spontaneous ilio-psoas hematoma as a consequence of either prophylactic or therapeutic anticoagulation with LMWH [109]. None of these patients were receiving KRT.…”