Psoas Major and Iliopsoas Hematomas without Anticoagulant Therapy as a Complication of Carbon Monoxide Poisoning: A Case Report

Abstract

BACKGROUND Carbon monoxide poisoning is a common reason for Emergency Department admissions worldwide. The symptoms of carbon monoxide poisoning vary from headache and dizziness to severe neuropsychological and cardiac impairment. However, psoas major and iliopsoas hematomas are a rare complication of carbon monoxide poisoning. CASE REPORT A 46-year-old man with carbon monoxide poisoning, after he had been exposed to burning coal without proper ventilation, presented with right low back pain on day 7 after onset. After 2 days, ecchymosis of the right flank occurred, and his hemoglobin concentration gradually decreased. Psoas major and iliopsoas hematomas were shown on computed tomography (CT). The hematomas were successfully treated with transfusions and physical therapy. Owing to the absence of skeletal muscle compartment syndrome, surgical decompression was unnecessary. The patient did not receive anticoagulant therapy during his hospitalization. CONCLUSIONS The direct toxicity of carbon monoxide on the muscles and body weight-induced muscle compression caused skeletal muscle ischemia and necrosis in our patient. The risk of rhabdomyolysis and coagulation abnormality was elevated. Finally, intramuscular hemorrhages occurred in our patient. When a patient has back pain and decreased hemoglobin levels, clinicians should consider the possibility of psoas major and iliopsoas hematomas, and the administration of anticoagulation should be used with caution after admission.

Figure 1.

The abdominal computed tomography scan on day 9. White arrows (↓) indicate the hematomas in the bilateral psoas major and iliopsoas (A, B). On the right side, the white arrow indicates (A) the accumulation of blood in the psoas major with the mean value of 19 Hounsfield units, and (B) the fascia between psoas major and iliopsoas with thickening and swelling.