Psoas hematoma in the elderly patient, a diagnostic challenge, a case report

BACKGROUND: A psoas hematoma is an uncommon condition in patients on anticoagulant therapy and patients with bleeding disorders. It can present itself with non-specific symptoms, as anemia, pain and hemodynamically instability. The CT angioscan is the diagnostic test of choice. CASE PRESENTATION: We report a series of 3 cases of iliopsoas hematoma in older patients. These patients were all on anticoagulant therapy and presented with non-specific symptoms as pain in back or groin, anemia and weakness of the leg. These symptoms could be well explained by other, concurrent diseases. Moreover in one case it was not possible to obtain a reliable history due to cognitive impairment of the patient. In our cases the diagnosis of a psoas hematoma was made after performing many diagnostics or found fortuitously. All three patients recovered well after (temporarily) ceasing of anticoagulant therapy. DISCUSSION: The diagnosis of a psoas hematoma is difficult, especially in elderly patients as illustrated in these cases. The symptoms of a psoas hematoma are often aspecific and can also be explained by other, comorbid diseases. Moreover, elderly patients often have an unusual presentation of illness and the presence of cognitive impairment compromises the reliability of a patients history. It is important to be aware of this diagnosis and perform a CT-scan when a psoas hematoma is possible. CONCLUSION: A psoas hematoma is easily overlooked in older patients due to an unusual presentation of illness, comorbidity and cognitive impairment.