Clinical Case Analysis of Iliopsoas Hematoma Causing with Femoral Nerve Compression

Abstract Background: To investigate the clinical manifestation and prognosis of iliopsoas hematoma (IPH) associated with femoral nerve compression and enhance the current understanding of IPH. Methods: Patients diagnosed with IPH from March 2014 to January 2023 at the Affiliated Hospital of Southwest Medical University were assessed. The main clinical indicator observed was visual analog scale (VAS) score before treatment as well as at 1 week and 1, 3, and 6 months after treatment. Secondary indicators included the degree of lower limb numbness before and after treatment, muscle strength, hip flexion degree, the distribution of affected nerves, hematoma size, and hematoma distribution. Results: A total of 28 patients were included, among which 24 were men, and the average age (median [interquartile range]) was 48 (20.25, 63) years. The average duration of disease onset was 3 (1.25, 7) days, and 16 patients (57.14%) exhibited coagulation dysfunction. After 1 week of treatment, a 50% reduction in the VAS score was noted in 18 patients (64.28%). Furthermore, VAS score at 1 week and 1, 3, and 6 months after treatment were significantly lower than the baseline VAS score ( P < 0.05). Baseline lower limb sensation was grade I in two patients, followed by grades II, III, and IV in five, 11, and 10 patients, respectively. After 6 months, 22 patients (78.57%) recovered to grade I. Baseline muscle strength of the lower limb was grade II in one patient, while grades III, IV, and V were in 10, eight, and nine patients, respectively. After 6 months, 19 patients (67.85%) exhibited improvement to grade V. The baseline degree of hip flexion was graded I and II in 53.57% of the patients, with enhancement to grade III after 6 months in 25 (89.28%). Hematoma distribution was localized in the mid-zone in 21% of the patients; upper-mid zone, 29%; mid-lower zone, 29%; and upper-mid-lower zone, 21%. In terms of affected nerves, femoral nerve involvement was revealed in 25 patients (89.28%), whereas lateral femoral cutaneous nerve involvement in 15 (53.57%). Conclusions: IPH is mainly caused by coagulation dysfunction and is often accompanied by pain and femoral nerve involvement that result in slow neurological recovery. Furthermore, the timely detection and causal treatment of IPH may help achieve a favorable prognosis.