Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy

  • Kong, Woo-Keun (Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Cho, Keun-Tae (Department of Neurosurgery, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Lee, Ho-Jun (Department of Rehabilitation Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Choi, Jae-Sung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Boramae Hospital)
  • Received : 2011.05.20
  • Accepted : 2012.01.11
  • Published : 2012.01.28


Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We report here on a rare case of a spontaneous iliacus muscle hematoma that caused femoral neuropathy in a patient who was taking warfarin for occlusive vascular disease and we discuss the treatment.


  1. Ashrani AA, Osip J, Christie B, Key NS : Iliopsoas haemorrhage in patients with bleeding disorders--experience from one centre. Haemophilia 9 : 721-726, 2003
  2. Balkan C, Kavakli K, Karapinar D : Iliopsoas haemorrhage in patients with haemophilia : results from one centre. Haemophilia 11 : 463-467, 2005
  3. Goodfellow J, Fearn CB, Matthews JM : Iliacus haematoma. A common complication of haemophilia. J Bone Joint Surg Br 49 : 748-756, 1967
  4. Guha SC, Poole MD : Stress fracture of the iliac bone with subfascial femoral neuropathy : unusual complications at a bone graft donor site : case report. Br J Plast Surg 36 : 305-306, 1983
  5. Guivarc'h M : [Hematoma of the iliac psoas muscle. 29 cases]. J Chir (Paris) 134 : 382-389, 1997
  6. Marquardt G, Barduzal Angles S, Leheta F, Seifert V : Spontaneous haematoma of the iliac psoas muscle : a case report and review of the literature. Arch Orthop Trauma Surg 122 : 109-111, 2002
  7. Merrick HW, Zeiss J, Woldenberg LS : Percutaneous decompression for femoral neuropathy secondary to heparin-induced retroperitoneal hematoma : case report and review of the literature. Am Surg 57 : 706-711, 1991
  8. Nakamura Y, Mitsui H, Toh S, Hayashi Y : Femoral nerve palsy associated with iliacus hematoma following pseudoaneurysm after revision hip arthroplasty. J Arthroplasty 23 : 1240.e1-e4, 2008
  9. Nakao A, Sakagami K, Mitsuoka S, Uda M, Tanaka N : Retroperitoneal hematoma associated with femoral neuropathy : a complication under antiplatelets therapy. Acta Med Okayama 55 : 363-366, 2001
  10. Nobel W, Marks SC Jr, Kubik S : The anatomical basis for femoral nerve palsy following iliacus hematoma. J Neurosurg 52 : 533-540, 1980
  11. Parmer SS, Carpenter JP, Fairman RM, Velazquez OC, Mitchell ME : Femoral neuropathy following retroperitoneal hemorrhage : case series and review of the literature. Ann Vasc Surg 20 : 536-540, 2006
  12. Pirouzmand F, Midha R : Subacute femoral compressive neuropathy from iliacus compartment hematoma. Can J Neurol Sci 28 : 155-158, 2001
  13. Qanadli SD, El Hajjam M, Mignon F, Bruckert F, Chagnon S, Lacombe P : Life-threatening spontaneous psoas haematoma treated by transcatheter arterial embolization. Eur Radiol 9 : 1231-1234, 1999
  14. Rochman AS, Vitarbo E, Levi AD : Femoral nerve palsy secondary to traumatic pseudoaneurysm and iliacus hematoma. J Neurosurg 102 : 382-385, 2005
  15. Wada Y, Yanagihara C, Nishimura Y : Bilateral iliopsoas hematomas complicating anticoagulant therapy. Intern Med 44 : 641-643, 2005
  16. Wicky S, Mayor B, Schnyder P : Clinical impact of imaging iliopsoas hematomas during anticoagulation. Emerg Radiol 2 : 2-6, 1995