1610 - Leg Weakness as Presenting Symptom of Retroperitoneal Hematoma from Femoral Neuropathy

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

MS

Monata Song, DO

Resident
ABBEL Research Division, Rehabilitation Institute at Sinai (formerly Sinai Rehabilitation Center), Sinai Hospital of Baltimore
Baltimore, Maryland, United States

Co-Author(s)

BM

Breena L. Miller, MS

Medical Student
A.T. Still University School of Osteopathic Medicine in Arizona
Tempe, Arizona, United States
JW

Jordan Wickstrom, PhD

Director of Clinical Research at ABBEL Research Division
ABBEL Research Division, Rehabilitation Institute at Sinai (formerly Sinai Rehabilitation Center), Sinai Hospital of Baltimore
Baltimore, Maryland, United States

Corresponding Author(s)

SE

Sarah Eby, MD, PhD

Assistant Professor
Harvard Medical School / Spaulding Rehabilitation Hospital
Charlestown, Massachusetts, United States

Submitter(s)

MS

Monata Song, DO

Sinai Hospital of Baltimore
Baltimore, Maryland, United States

Case Diagnosis: Femoral Neuropathy secondary to Retroperitoneal Hematoma

Case Description: Physical Medicine and Rehabilitation (PM&R) was consulted for a 66-year-old male with debility after a prolonged hospitalization and ICU stay. He presented with acute hypoxic respiratory failure and atrial fibrillation with rapid ventricular response requiring anticoagulation. Physical therapy identified weakness in left hip flexion and extension, and the patient noted decreased sensation in his left lower extremity. Brain and lumbar spine MRI were nonconfirmatory, and no further workup was done. After an episode of hypotension and severe anemia, a CT angiography of the abdomen/pelvis revealed a large retroperitoneal iliopsoas hematoma secondary to venous bleeding. PM&R concluded the patient’s unilateral lower extremity weakness was due to left femoral neuropathy and iliopsoas compression from the hematoma. Pelvic MRI and electromyography confirmed femoral neuropathy. The patient was discharged to acute inpatient rehabilitation with neuropathic pain management.

Discussions: This patient’s left leg weakness was the first sign of an underlying and potentially fatal pathology. It was not until the patient’s vitals declined that further diagnostics were pursued, and a retroperitoneal hematoma was identified. Linking the hematoma location to the patient’s physical exam by PM&R was key to diagnosing femoral neuropathy, leading to efficient treatment and rehabilitation. This case demonstrates that retroperitoneal hematoma should be included in the differential diagnosis of unilateral proximal leg weakness and sensory impairment, particularly in patients on anticoagulation.

Conclusions: Sudden change in the neuromuscular system can be the first sign of many pathologies other than stroke, spine disease, or trauma. Having access to a multidisciplinary model and team assists clinicians in directing more attention to otherwise unexplained symptoms, allowing for earlier recognition, intervention, and recovery. This case highlights the critical role of physiatric assessment in identifying uncommon causes of weakness and directing timely rehabilitation.