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

Abstract

in the groin that radiated to the left anterior thigh. After the sudden onset of the pain, weakness on the left lower extremity developed and this had worsened for one week. He had a previous history of a thrombectomy in the left femoral artery two years before and in the left external iliac artery one month before. He had taken warfarin for two years after the first thrombectomy. On admission, his vital signs were stable. His prothrombin time international normalized ratio was 1.6, the hemoglobin was 9.7 g/dL and the platelet count was 22310 3 / L. Physical examination revealed paresis of the left quadriceps muscle with strength of 4/5 and a diminished knee jerk reflex. The femoral, popliteal and dorsalis pedis pulses were palpable but slightly weak and no change in the skin color was found. He kept the left knee flexed and complained of aggravated pain when he extended the knee. Initially, vascular insufficiency due to partial arterial occlusion by thrombus was suspected. But computed tomography (CT) angiography and Doppler ultrasonography revealed patent proximal arteries and intact flows on the lower extremities. The source images for CT angiography revealed the iliacus muscle hematoma (Fig. Because the left psoas muscle was compressed and displaced by the hematoma compared with right psoas muscle and the femoral nerve runs between the psoas tendon and the iliacus muscle, compression or displacement of the left femoral nerve was suspected. The