30 October 2017 : Case report
Deep Vein Thrombosis Complicated by Spontaneous Iliopsoas Hematoma in Patient with Septic Shock
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Educational Purpose (only if useful for a systematic review or synthesis), Rare coexistence of disease or pathology
Muhammad Umer Butt1ABCDEF*, Lili A. Buzsaki2E, Susan S. Smyth1DEF, Samy-Claude Elayi1DEFDOI: 10.12659/AJCR.905628
Am J Case Rep 2017; 18:1148-1152
Abstract
BACKGROUND: Spontaneous retroperitoneal hemorrhage (SRH) is a rare and difficult-to-diagnose entity. It is not associated with trauma, pathology, or iatrogenic manipulations. Few cases have been reported, with the only precipitating factor recognized being bleeding diatheses such as anticoagulation states, inherited coagulopathies, and hemodialysis. However, none of these have been described in combination with septic shock, which itself is associated with platelet dysfunction, coagulation dysfunction, and vasculopathy.
CASE REPORT: Our case involves an elderly man presenting with altered mental status of unknown etiology, in addition to hemodynamic instability, presumably due to septic shock, without any overt signs of bleeding. After his initial exam revealed lower-extremity edema and decubitus ulcers, a venous Doppler was performed, which revealed extensive deep vein thrombosis. It was unknown whether the sepsis or DVT occurred first. Therapeutic anticoagulation with heparin was subsequently started. On hospital day 4, a CT abdomen with contrast identified retroperitoneal hematoma after the patient’s hemoglobin lowered without any overt signs of bleeding. The diagnosis of spontaneous retroperitoneal hematoma was one of exclusion and posed a therapeutic dilemma (conservative versus invasive management).
CONCLUSIONS: Sepsis-related coagulopathy and heparin use in an elderly patient predisposed him to an iliopsoas hematoma. In this case, conservative management with reversal of anticoagulation and blood transfusion was sufficient to stabilize the patient.
Keywords: Blood Coagulation, Hematoma, Hemorrhage, Shock, Septic
In Press
16 Mar 2024 : Case report
A Rare Autochthonous Case of Hepatic Hydatid Cyst in the Non-Endemic Region of TaiwanAm J Case Rep In Press; DOI: 10.12659/AJCR.943687
17 Mar 2024 : Case report
Contrast-Enhanced Ultrasonography in Diagnosing Intravascular Large B-Cell Lymphoma Infiltrating Liver Sinu...Am J Case Rep In Press; DOI: 10.12659/AJCR.943070
17 Mar 2024 : Case report
Rare Presentation of Rapidly Involuting Congenital Hemangioma of the Skull: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943370
18 Mar 2024 : Case report
Perineal Benign Symmetric Lipomatosis in a Female Patient: A Case ReportAm J Case Rep In Press; DOI: 10.12659/AJCR.943803
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250