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Spontaneous pulmonary hematoma in patients with COVID-19. RADIOLOGIA 2023; 65:176-179. [PMID: 37059582 PMCID: PMC10020037 DOI: 10.1016/j.rxeng.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/29/2021] [Indexed: 03/19/2023]
Abstract
The disease caused by Sars-Cov-2 (Covid-19) has become a worldwide pandemic and consequently a public health problem. Multiple complications associated with Covid-19 have been described, including coagulation abnormalities. Although the infection is known to induce a prothrombotic state, hemorrhagic complications have also been reported in patients with Covid-19, especially in anticoagulated patients. We present two cases of spontaneous pulmonary hematoma in patients with Covid-19 undergoing anticoagulant treatment. We aim to describe this complication, which although uncommon, should be taken into account in anticoagulated patients with Covid-19.
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Lozano C, González A, Andreu M, Castañer E. [Spontaneous pulmonary hematoma in patients with COVID-19]. RADIOLOGIA 2023; 65:176-179. [PMID: 35370312 PMCID: PMC8610840 DOI: 10.1016/j.rx.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/29/2021] [Indexed: 11/26/2022]
Abstract
The disease caused by Sars-Cov-2 (Covid-19) has become a worldwide pandemic and consequently a public health problem. Multiple complications associated with Covid-19 have been described, including coagulation abnormalities. Although the infection is known to induce a prothrombotic state, hemorrhagic complications have also been reported in patients with Covid-19, especially in anticoagulated patients. We present two cases of spontaneous pulmonary hematoma in patients with Covid-19 undergoing anticoagulant treatment. We aim to describe this complication, which although uncommon, should be taken into account in anticoagulated patients with Covid-19.
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Affiliation(s)
- C Lozano
- UDIAT-Centro Diagnóstico, Servicio de Diagnóstico por la Imagen, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, España
| | - A González
- UDIAT-Centro Diagnóstico, Servicio de Diagnóstico por la Imagen, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, España
| | - M Andreu
- UDIAT-Centro Diagnóstico, Servicio de Diagnóstico por la Imagen, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, España
| | - E Castañer
- UDIAT-Centro Diagnóstico, Servicio de Diagnóstico por la Imagen, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, España
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Petreanu CA, Vlăsceanu S, Zaharia D, Jipa D, Moldovan H, Gheorghiță D, Iliuță L, Rădulescu B, Bădărău IA, Savu CF. Spontaneous Pulmonary Hematoma: Case Report of a Giant Post-COVID-19 Hematoma and Literature Review. Healthcare (Basel) 2023; 11:healthcare11040527. [PMID: 36833061 PMCID: PMC9957326 DOI: 10.3390/healthcare11040527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 02/12/2023] Open
Abstract
Pulmonary hematomas are a rare pathology. Although they are usually reported post-traumatically, there are also spontaneous forms in pulmonary pathologies or during drug therapy. In these spontaneous entities, primitive forms are rarely described, although the contributory local pulmonary pathological terrain or a specific associated medication has not yet been identified. We present the case of a patient who developed a giant pulmonary hematoma that appeared spontaneously during recovery from COVID-19 infection. It appeared in one of the two bullae-like cystic lung lesions developed during secondary COVID-19 infection. The clinical impact was major, with hypotension and anemia being observed, requiring hemodynamic support and the adjustment of drug therapy. The clinical course was favorable, with a quasi-complete resolution of both the hematoma and a second cystic lesion being observable at 8 months by pulmonary remodeling. Spontaneous pulmonary hematomas may constitute a pathological entity associated with a post-COVID-19 remodeling process of the lung and the related anticoagulant treatment, which should be recognized, especially in the actual COVID-19 pandemic or in the widespread use of anticoagulant treatment. Conservative treatment is the method of choice, even in giant lung forms.
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Affiliation(s)
- Cornel Adrian Petreanu
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050152 Bucharest, Romania
- Thoracic Surgery Clinic I, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Silviu Vlăsceanu
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050152 Bucharest, Romania
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania
- Correspondence: (S.V.); (H.M.)
| | - Dragoș Zaharia
- Department of Pneumology, “Marius Nasta” National Institute of Pneumology, 050152 Bucharest, Romania
- Pneumology Clinic, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Daniela Jipa
- Department of Pneumology, “Marius Nasta” National Institute of Pneumology, 050152 Bucharest, Romania
- Pneumology Clinic, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Horațiu Moldovan
- Department of Cardiovascular Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Clinical Emergency Hospital Bucharest, 014461 Bucharest, Romania
- Academy of Romanian Scientists, 050045 Bucharest, Romania
- Correspondence: (S.V.); (H.M.)
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania
| | - Luminița Iliuță
- Department of Medical Informatics and Biostatistics, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Bogdan Rădulescu
- Department of Cardiovascular Surgery, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Cardiovascular Surgery, Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Ioana Anca Bădărău
- Department of Physiology, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania
| | - Cornel Florentin Savu
- Department of Thoracic Surgery, “Marius Nasta” National Institute of Pneumology, 050152 Bucharest, Romania
- Thoracic Surgery Clinic I, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania
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Kawagishi S, Kogita Y, Nakamichi I, Matsui T, Tokunaga T. A case of unusually persistent traumatic intrapulmonary hematoma. Respir Med Case Rep 2021; 34:101507. [PMID: 34540579 PMCID: PMC8437819 DOI: 10.1016/j.rmcr.2021.101507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/17/2021] [Accepted: 09/01/2021] [Indexed: 11/20/2022] Open
Abstract
Intrapulmonary hematomas are collections of blood within alveolar and interstitial spaces. They occur mainly following thoracic trauma. Typically, intrapulmonary hematomas without bleeding or infection spontaneously disappear after several weeks to 6 months. In the current case, the patient presented with an intrapulmonary nodule 17 months after a chest injury. The size of the nodule had not changed at 4 months after the first visit. Consequently, the patient was diagnosed with an intrapulmonary hematoma by surgical resection. To our knowledge, there are no previous studies that described the cause of the persistent intrapulmonary hematoma. This study reports the case of a patient who underwent surgical resection of a persistent traumatic intrapulmonary hematoma.
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Affiliation(s)
- Sachi Kawagishi
- Department of General Thoracic Surgery, Minoh City Hospital, 5-7-1, Kayano, Minoh, Osaka, 562-0014, Japan
- Corresponding author. Department of General Thoracic Surgery Minoh City Hospital, Kayano 5-7-1, Minoh, Osaka, 562-0014, Japan.
| | - Yuya Kogita
- Department of General Thoracic Surgery, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1, Toneyama, Toyonaka, Osaka, 560-8552, Japan
| | - Itsuko Nakamichi
- Department of Pathology, Minoh City Hospital, 5-7-1, Kayano, Minoh, Osaka, 562-0014, Japan
| | - Takahiro Matsui
- Department of Pathology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka Suita, Osaka, 565-0871, Japan
| | - Toshiteru Tokunaga
- Department of General Thoracic Surgery, Minoh City Hospital, 5-7-1, Kayano, Minoh, Osaka, 562-0014, Japan
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Brogna B, Romano A, Tibullo L, Montuori M, Nunziata M, Russo G, Musto LA. Rare findings of spontaneous hemothorax and small subpleural lung hematoma in a COVID-19 patient: A case report. Acta Radiol Open 2021; 10:20584601211028149. [PMID: 34367668 PMCID: PMC8326360 DOI: 10.1177/20584601211028149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/07/2021] [Indexed: 01/27/2023] Open
Abstract
Hemothorax (HT) and pulmonary hematoma represent rare complications of anticoagulant therapy. We present a rare case of a 53-year-old man with COVID-19 pneumonia who showed, in a follow-up computed tomography (CT) scan 13 days after hospitalization, a left HT and a small hyperdense area in a subpleural location and compatible with a small subpleural hematoma. This patient was being treated with a subcutaneous administration of low-molecular-weight heparin (100UI/kg/BID). No vascular malformations were visualized on the CT pulmonary angiography. Herein, we report the first case of both a spontaneous HT and a lung subpleural hematoma in a COVID-19 patient, probably caused by anticoagulant therapy.
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Affiliation(s)
- Barbara Brogna
- Department of Radiology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
- Barbara Brogna, Department of Radiology San Giuseppe Moscati Hospital Avellino, National Speciality Hospital San Giuseppe Moscati Neurology and Stroke Unit, Contrada Amoretta, Avellino 83100, Italy.
| | - Annamaria Romano
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Loredana Tibullo
- Department of General Medicine, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Mariagrazia Montuori
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Mariagrazia Nunziata
- Department of General Medicine, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Giuseppe Russo
- Department of Pneumology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
| | - Lanfranco A Musto
- Department of Radiology, San Giuseppe Moscati Hospital Avellino, Avellino, Italy
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Sonokawa T, Matsui T, Takegahara K, Inoue T, Kashiwada T, Terasaki Y, Usuda J. Spontaneous pulmonary hematoma with diffuse pulmonary ossification requiring emergency treatment: a case report. Surg Case Rep 2019; 5:27. [PMID: 30778690 PMCID: PMC6379494 DOI: 10.1186/s40792-019-0589-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/10/2019] [Indexed: 11/29/2022] Open
Abstract
Background Pulmonary hematoma is most often caused by thoracic trauma. However, rare cases of pulmonary hematoma without any obvious cause are sometimes reported, when the condition is referred to as spontaneous or idiopathic pulmonary hematoma. Herein, we report a very rare case—to the best of our knowledge, this is the first case of pulmonary hematoma associated with diffuse pulmonary ossification requiring emergency treatment reported in the English literature. Case presentation Our patient was a 44-year-old man with a history of IgA nephropathy and had no history of trauma or anticoagulant use. He presented with the chief complaint of bloody sputum and was referred to our hospital for detailed examination. Chest computed tomography showed a right pleural effusion and a large round mass in the right lower lobe. We performed chest tube drainage of the right thorax and confirmed bloody pleural effusion. Although bronchial artery embolization was performed, the patient’s anemia worsened, and we performed right lower lobectomy. Histopathological examination of the resected specimen showed a hematoma with diffuse pulmonary ossification, although the relationship between the two was unclear. There was no evidence of malignancy or angiitis. Therefore, we made the diagnosis of spontaneous pulmonary hematoma in this case. The postoperative course was uneventful. The patient is currently under observation as an outpatient, and a recent chest X-ray showed no evidence of recurrence. Conclusion We report a case of spontaneous pulmonary hematoma with diffuse pulmonary ossification. Although the relationship between the two remains unclear, considering the possibility of appearance of new lesions/recurrence, we believe that careful follow-up is necessary for this patient.
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Affiliation(s)
- Takumi Sonokawa
- Department of Thoracic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
| | - Takuma Matsui
- Department of Thoracic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Kyoshiro Takegahara
- Department of Thoracic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Tatsuya Inoue
- Department of Thoracic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Takeru Kashiwada
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
| | - Jitsuo Usuda
- Department of Thoracic Surgery, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan
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Ribeiro L, Silva J, Pinto CS. Spontaneous Pulmonary Hematoma as a Complication of Anticoagulant Therapy. Arch Bronconeumol 2018; 54:528-529. [PMID: 29576200 DOI: 10.1016/j.arbres.2018.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/15/2018] [Accepted: 02/12/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Liliana Ribeiro
- Department of Pulmonology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal.
| | - Joelma Silva
- Department of Pulmonology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
| | - Cláudia Sofia Pinto
- Department of Pulmonology, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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Vlaović J, Voga G. Spontaneous pulmonary hematoma in a patient with sepsis treated with dual antiplatelet therapy. Wien Klin Wochenschr 2016; 128:553-556. [PMID: 27796503 DOI: 10.1007/s00508-016-1107-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022]
Abstract
A 72-year-old patient was admitted to the medical intensive care unit due to a right-sided, hospital-acquired pneumonia and septic shock with respiratory failure and deterioration of chronic renal failure. During hospitalization the patient required hemodynamic support with norepinephrine and dobutamine, mechanical ventilation and hemodialysis. The patient suffered a non-ST segment elevation myocardial infarction (NSTEMI) and received dual antiplatelet therapy. After 14 days an acute intrapulmonary infiltrate of unknown origin developed, accompanied by fever and a significant increase of the C‑reactive protein (CRP) level. Chest radiography and a computed tomography (CT) scan showed a well-defined, round, high-attenuation lesion in the lungs and a suspected infected pulmonary hematoma, which was confirmed by percutaneous aspiration biopsy. There was no evidence of trauma and it is believed that the hematoma occurred spontaneously, probably because of the dual antiplatelet therapy. Double antibiotic treatment was started but no surgery was performed after consultation with a thoracic surgeon. The antiplatelet drugs were temporarily withdrawn until the size of the hematoma showed no further increase and then antiplatelet therapy was continued. After stabilization the patient was discharged from hospital and 6 months later a follow-up chest X‑ray showed almost complete resolution of the hematoma.
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Affiliation(s)
- Janko Vlaović
- Department of Intensive Internal Medicine, General Hospital Celje, Oblakova ulica 5, 3000, Celje, Slovenia.
| | - Gorazd Voga
- Department of Intensive Internal Medicine, General Hospital Celje, Oblakova ulica 5, 3000, Celje, Slovenia
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