Intralesional Alteplase as an Adjunct to Percutaneous Drainage for a Large Iliopsoas Muscle Hematoma in a Patient With Von Willebrand Disease: A Case Report

TL;DR

A woman with a bleeding disorder recovered from a large muscle hematoma using a combination of drainage and a clot-dissolving drug, avoiding surgery.

Contribution

Demonstrates a successful non-surgical treatment for iliopsoas hematoma in a patient with severe coagulopathy.

Findings

Percutaneous drainage with intralesional alteplase reduced the hematoma and resolved neuropathy.

The patient fully recovered and returned to daily activities within six weeks.

The approach is a safe alternative to surgery for coagulopathy patients.

Abstract

We present the case of a 32-year-old woman with type III von Willebrand disease who, after a chiropractic manipulation, developed a large iliopsoas muscle hematoma with femoral neuropathy. Given the lack of recombinant factor VIII at our institution, we opted for a minimally invasive, interdisciplinary approach. The patient was clinically stable and fully adherent to the proposed interdisciplinary management plan. A percutaneous drainage was placed and supplemented with intralesional alteplase irrigations, which allowed for a progressive reduction of the hematoma, resolution of the neuropathy, and the patient's complete recovery. The patient was discharged with minimal residual weakness, and at six weeks, imaging showed near-complete resolution of the collection and full return to daily activities. This case demonstrates the success of combining percutaneous drainage with fibrinolytic agents as an effective and safe alternative to conventional surgical management in patients with severe coagulopathies.

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