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

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.