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Observational Study
. 2021 Dec;53(1):295-301.
doi: 10.1080/07853890.2021.1875498.

Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients

Alessandra Vergori  1 , Elisa Pianura  2 , Patrizia Lorenzini  1 , Alessandra D'Abramo  3 , Federica Di Stefano  2 , Susanna Grisetti  1 , Serena Vita  3 , Carmela Pinnetti  1 , Davide Roberto Donno  4 , Maria Cristina Marini  5 , Emanuele Nicastri  3 , Stefania Ianniello  2 , Andrea Antinori  1 ; ReCOVeRI Study Group
Affiliations
Observational Study

Spontaneous ilio-psoas haematomas (IPHs): a warning for COVID-19 inpatients

Alessandra Vergori et al. Ann Med. 2021 Dec.

Abstract

Introduction: Critically ill patients with COVID-19 are at increased risk of developing a hypercoagulable state due to haemostatic changes directly related to the SARS-CoV-2 infection or to the consequence of the cytokine storm. Anticoagulation is now recommended to reduce the thrombotic risk. Ilio-psoas haematoma (IPH) is a potentially lethal condition that can arise during the hospitalization, especially in intensive care units (ICUs) and frequently reported as a complication of anticoagulation treatment.

Materials and methods: We report a case series of seven subjects with SARS-CoV-2 pneumonia complicated by Ilio-psoas haematomas (IPHs) at our COVID-Hospital in Rome, Italy.

Results: Over the observation period, 925 subjects with confirmed SARS-CoV-2 infection were admitted to our COVID-hospital. Among them, we found seven spontaneous IPHs with an incidence of 7.6 cases per 1000 hospitalization. All the reported cases had a severe manifestation of COVID-19 pneumonia, with at least one comorbidity and 5/7 were on treatment with low weight molecular heparin for micro or macro pulmonary thrombosis.

Conclusions: Given the indications to prescribe anticoagulant therapy in COVID-19 and the lack of solid evidences on the optimal dose and duration, it is important to be aware of the iliopsoas haematoma as a potentially serious complication in COVID-19 inpatients. KEY MESSAGE Critically ill patients with COVID-19 are at increased risk of hypercoagulability state and anticoagulation therapy is recommended. Ilio-psoas haematoma (IPH) is found to be a complication of anticoagulation regimen especially in severe COVID-19 cases. An incidence of 7.6 cases per 1000 admission of IPHs was reported. Hypoesthesia of the lower limbs, pain triggered by femoral rotation, hypovolaemia and anaemia are the most common symptoms and signs of IPHs that should alert physician.

Keywords: COVID-19; Ilio-psoas haematoma; heparin.

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Conflict of interest statement

All the authors have no competing interests that might be perceived to influence the results and/or discussion reported in this paper. Outside of this submitted work: Alessandra Vergori received institutional grant from Gilead Sciences, personal fees and travel grant from Janssen, personal fee from MSD; Andrea Antinori has served as a paid consultant to Gilead Sciences, Janssen-Cilag, Merck and ViiV Healthcare and received research institutional grants from Gilead Sciences, Janssen-Cilag and ViiV Healthcare. The other co-authors declare no conflicts of interests outside the submitted work.

Figures

Figure 1.
Figure 1.
(a) Arterial phase CT of right haematoma and (b) delayed phase CT of right haematoma.
Figure 2.
Figure 2.
(a) MRI of right iliopsoas haematoma, (b) MRI of right iliopsoas haematoma and (c) MRI of right iliopsoas haematoma.
See this image and copyright information in PMC

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