[Hematoma of the iliac psoas secondary to anticoagulant treatment. Urological implications]

Abstract

We describe the urological manifestations arising from hematoma of the left iliac psoas that developed in the course of anticoagulant therapy in a 54-year-old patient with a mitral prosthesis. The onset of the clinical picture was acute and mimicked left reno-ureteral colic. Ultrasound and CT were decisive in making the diagnosis, revealing a left retroperitoneal mass in the anterolateral aspect of the left psoas muscle. Intravenous urography evidenced the urological repercussions of the disease process consisting of medialization of the left ureter, ureterohydronephrosis, and anterior and lateral displacement of the kidney. Although this condition is considered by most to be a surgical emergency, we opted for conservative treatment because the patient had no hemodynamic instability, severe obstructive uropathy or signs or crural paralysis. The literature on the urological repercussions of psoas hematomas due to anticoagulant therapy is briefly reviewed.