Warfarin Induced Iliopsoas Hematoma Detected by Bedside Emergency Ultrasonography

Warfarin is frequently used as an oral anticoagulant in a variety of clinical settings, e.g. atrial fibrillation or following valvular heart disease. The most serious and common complication associated with anticoagulation using warfarin is bleeding. Hemorrhage into the iliopsoas muscle causing femoral neuropathy is an infrequent complication of anticoagulant therapy. Two women, 53 and 70 year-old, each with a history of mitral valve replacement surgery, presented at the emergency department with right hip pain. They had been taking warfarin 5 mg once a day since their operations. Physical examinations were normal except for the right hip pain,on movement and femoral nerve palsy in the second patient. Prothrombin, activated prothrombin time and international normalized ratio were prolonged. In order to make the differential diagnosis, we decided to perform bedside emergency ultrasound examination. Ultrasound examination of the patients showed an anechoic lesion in the area of the right iliopsoas muscle. They were admitted to hospital for observation and treatment. Fresh frozen plasma and vitamin K were given for treatment. The possibility of iliopsoas hematoma should be considered in any patient with hip pain undergoing anticoagulant treatment.