Summary
Pain around the hip joint and femoral neuropathy in a patient with a bleeding coagulopathy should alert the physician to the possibility of an iliopsoas haematoma. Unfortunately this diagnosis is often missed. Clinically, reduced hip motion, a mass in the iliac fossa and alteration in the motor and sensory function of the femoral nerve may be noted. If the pain is on the right side, appendicitis must be excluded. Ultrasound is the diagnostic aid of choice, being more sensitive than computerized tomography or radioisotope investigations. Treatment should be gradual, gentle and protracted to avoid recurrent bleeding episodes.
Zusammenfassung
Schmerzen in der Hüftregion und N. femoralis Neuropathie bei einem Patienten mit Hämophilie sollten den Arzt auf ein mögliches Iliopsoas-Hämatom aufmerksam machen. Unglücklicherweise wird these Diagnose oft verfehlt.
Klinisch feststellbar sind: reduzierte Beweglichkeit im Hüftgelenk, eine Masse in der Fossa iliacka und motorische und sensorische Veränderungen im Innervationsgebiet des N. femoralis. Bei rechtsseitigen Schmerzen muß eine Appendicitis ausgeschlossen werden. Ultraschall ist das diagnostische Hilfsmittel der Wahl; es ist empfindlicher als die Computer-Tomographie oder Radionukliduntersuchungen.
Die Behandlung sollte stufenweise, vorsichtig und langsam verlaufen, um wiederholte Blutungen zu verhindern.
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Heim, M., Horoszowski, H., Seligsohn, U. et al. Ilio-psoas hematoma—its detection, and treatment with special reference to hemophilia. Arch. Orth. Traum. Surg. 99, 195–197 (1982). https://doi.org/10.1007/BF00379208
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DOI: https://doi.org/10.1007/BF00379208