Keikhaei and Soltani Shirazi Journal of Medical Case Reports 2011, 5:274 http://www.jmedicalcasereports.com/content/5/1/274 However, his physical examination showed that he had an anxious and painful facial expression. There was severe tenderness on palpation of the right flank. No mass was found. His pain radiated to the hip joint and the inguinal region. He supported himself with a stick and could not stand up on his legs. The patient exhibited an anti-pain posture and held his right leg flexed at the hip joint (Fig- ure 1). He had hypoesthesia on the anterior aspect of his right thigh (Figure 1). His knee tendon reflex was weak, and weakness of his quadriceps muscle was demonstrable. A plain abdominal X-ray demonstrated lack of clarity at the right psoas muscle line. Magnetic resonance imaging (MRI) showed a hematoma in the right iliopsoas muscle (Figure 2). He was treated with Humate-P at a dose of 40 IU/kg body weight twice daily. The dose was calculated on the basis of factor VIII coagulation. He was treated with the Humate-P regimen for three days, after which his symptoms resolved completely and he resumed walking without support. The treatment continued for the next three days. At present, he has been well for three months and has not experienced any further symptoms or compli- cations. His follow-up physical examination showed a healthy quadriceps muscle function, a good patellar ten- don reflex and an intact sensory femoral nerve. Discussion Iliopsoas hemorrhage, whether spontaneous or trau- matic, is encountered in a variety of coagulation disor- ders, such as hemophilia and vWD, and in association with anti-coagulant drug treatments such as heparin, warfarin and ticlopidine; however, most cases of iliop- soas hemorrhage occur in patients with hemophilia [3], and the first case was reported by Tallroth in 1939 [4]. The diagnosis of retroperitoneal hematoma is made on the basis of ultrasonography, computed tomography and MRI. The treatment of patients with iliopsoas muscle Figure 1 Anti-pain posture showing marked hypoesthesia area. Page 2 of 3 Figure 2 MRI scan shows a large hyper signal mass in the right iliopsoas muscle hemorrhage remains controversial. Some experts con- sider that surgical decompression (open or percutaneous aspiration) is the treatment of choice because it mini- mizes neurological deficits. Others have advocated a medical approach. Non-operative treatment consists of complete rest and replacement factor therapy. Iliopsoas hemorrhage occurs mostly in patients with hemophilia after trauma (falling from height), but our patient had no history of trauma. Good results were achieved by administering Humate-P treatment to our patient [5]. Conclusion This report describes the case of a patient with vWD type 3 who had a spontaneous iliopsoas hematoma. The diagnosis was established on the basis of MRI, and the patient showed a good response to Humate-P treatment. We could not find any similar case reported in the med- ical literature, and we think that our case report may be the first of its kind to be published. The publication of this article may raise the clinician’s awareness of the treatment of iliopsoas hematoma in patients with vWD. Consent Written informed consent was obtained from the patient for publication of this case report and any accompany- ing images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Author details 1Department of Thalassemia & Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Science, Shafa Hospital (Golestan Area), Ahvaz 61357-33119, Iran. 2Department of Radiology, Ahvaz Jundishapur