Unveiling the Hidden Perils: Spontaneous Iliacus Muscle Hematoma Induced by Rivaroxaban Therapy

A 56-year-old hypertensive male presented to the Emergency Department with acute-onset dyspnea at rest, persisting for three days. Examination revealed hypoxemia (SpO₂ 88% on room air) with normal chest auscultation. Laboratory investigations showed no significant abnormalities except elevated D-dimer levels. Urgent CT pulmonary angiography confirmed acute thrombosis of segmental branches of the right pulmonary artery with severe pulmonary artery hypertension on 2D echocardiography. Treatment with rivaroxaban was initiated. However, after four days, the patient developed left thigh pain and difficulty with hip flexion. Imaging revealed a left iliacus muscle hematoma, prompting the discontinuation of Rivaroxaban and CT-guided drainage by the interventional radiology team. Symptoms gradually resolved post-drainage. This case highlights the potential complication of anticoagulant therapyinduced hematoma formation, necessitating prompt intervention.