Spontaneous Iliopsoas Muscle Hemorrhage–Predictors of Associated Mortality

      Rationale and Objectives

      Spontaneous iliopsoas muscle hemorrhage (SIPH) is a rare clinical condition associated with high mortality. In this work we aimed to retrospectively investigate the predictors of mortality in a single-institution cohort of consecutive SIPH patients.

      Materials and Methods

      Consecutive patients (n = 61, 30 men, 76 years [range 51–93]) with computed tomography (CT) confirmed diagnosis of SIPH were retrospectively included between January 2010 and April 2020. CT studies were assessed for signs of active bleeding, extramuscular retroperitoneal hematoma, visible sedimentation, and hematoma volume. Medication history, laboratory parameters, comorbidities, and disease management were also recorded. All parameters were subsequently examined with regard to their impact on outcome and survival. Univariate and multivariate Cox regressions were performed to identify variables associated with time to death.


      The overall mortality was 22.9%. A total of 77% of patients received anticoagulant therapy prior to the onset of SIPH. Active bleeding in contrast enhanced CT (CECT) was the only independent variable associated with shorter survival (p = 0.01, hazard ratio 7.05 [1.45–34.20]). Hematoma volume or extramuscular retroperitoneal hematoma had no significant influence on short-term mortality.


      Only active bleeding but not hematoma volume or extra-muscular bleeding is an independent risk factor for short-term mortality in patients with SIPH.

      Key Words


      SIPH (spontaneous iliopsoas muscle hemorrhage), CT (computed tomography), CECT (contrast enhanced computed tomography), SSTH (spontaneous soft tissue hemorrhage), MRI (magnetic resonance imaging), ICU (intensive care unit), TAE (trans-arterial embolization), DSA (digital subtraction angiography), OR (odds ratio), HR (hazard ratio), CI (confidence interval)
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