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Sha S, Qi S, Qindong S. Multisite spontaneous hematomas and bleeding in critically ill Chinese patients with COVID-19: two case reports and a literature review. BMC Infect Dis 2024; 24:101. [PMID: 38238658 PMCID: PMC10797968 DOI: 10.1186/s12879-024-09012-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Anticoagulation is recommended as a standardized therapy for COVID-19 patients according to the WHO guidelines. However, bleeding events have also been reported. Hemorrhage or hematoma was observed in sites including the retroperitoneum, brain, alimentary tract, muscles, and soft tissues. Reduction or suspension of anticoagulants is a common intervention. Transfusion, endoscopic hemostasis, and vascular interventional therapy have been used to improve the condition. CASE PRESENTATION In this article, we present two cases of concurrent multisite hematomas and bleeding at other sites in patients with SARS-CoV-2 infection. Both patients were treated with heparins and experienced bleeding after the anticoagulation therapy. Both patients were older with more than two comorbidities, and critical COVID-19. Laboratory tests revealed a considerable decrease in hemoglobin levels and alterations in the coagulation system. In the first patient, the main intervention was embolization using angiography. However, we only adjusted the anticoagulation strategy in the second case. The first patient recovered and was discharged; however, the second died of other causes. This study provides a retrospective review of typical hemorrhagic cases during anticoagulation in COVID-19 patients over the course of four years. A relatively comprehensive search was performed in Pubmed by constructing MeSH subject terms on limiting the search period and specific contents. It summarizes and synthesizes the research related to heparins and other novel anticoagulants in the context of COVID-19 from the onset of the pandemic to the present disseminated phase. This study aimed to offer valuable insights and reference points for developing anticoagulation treatment strategies for patients with COVID-19. CONCLUSIONS Anticoagulation is a crucial treatment option for patients with COVID-19. The difference in anticoagulant effects is related to the severity of COVID-19. Nafamostat can reduce thrombosis in the extracorporeal circuits in critically ill patients with COVID-19. The efficacy and safety of novel anticoagulants require further clinical data. Routine bedside assessments and real-time laboratory monitoring are essential for early identification of bleeding events during anticoagulant therapy and administering intervention.
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Affiliation(s)
- Sha Sha
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Intensive Care Medicine, the Power Central Hospital of Genertec Guozhong Healthcare Limited Company, Xi'an, Shaanxi, 710032, China
| | - Sun Qi
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Shi Qindong
- Department of Critical Care Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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2
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Minici R, Fontana F, Venturini M, Guzzardi G, Siciliano A, Piacentino F, Serra R, Coppola A, Guerriero P, Apollonio B, Santoro R, Team MGJRR, Brunese L, Laganà D. Transcatheter Arterial Embolization (TAE) in the Management of Bleeding in the COVID-19 Patient. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1062. [PMID: 37374266 PMCID: PMC10305036 DOI: 10.3390/medicina59061062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Increasing attention is being paid to the coagulation disorders associated with SARS-CoV-2 infection. Bleeding accounts for 3-6% of COVID-19 patient deaths, and is often a forgotten part of the disease. The bleeding risk is enhanced by several factors, including spontaneous heparin-induced thrombocytopenia, thrombocytopenia, the hyperfibrinolytic state, the consumption of coagulation factors, and thromboprophylaxis with anticoagulants. This study aims to assess the efficacy and safety of TAE in the management of bleeding in COVID-19 patients. Materials and Methods: This multicenter retrospective study analyzes data from COVID-19 patients subjected to transcatheter arterial embolization for the management of bleeding from February 2020 to January 2023. Results: Transcatheter arterial embolization was performed in 73 COVID-19 patients for acute non-neurovascular bleeding during the study interval (February 2020-January 2023). Coagulopathy was observed in forty-four (60.3%) patients. The primary cause of bleeding was spontaneous soft tissue hematoma (63%). A 100% technical success rate was recorded; six cases of rebleeding resulted in a 91.8% clinical success rate. No cases of non-target embolization were observed. Complications were recorded in 13 (17.8%) patients. The efficacy and safety endpoints did not differ significantly between the coagulopathy and non-coagulopathy groups. Conclusions: Transcatheter Arterial Embolization (TAE) is an effective, safe and potentially life-saving option for the management of acute non-neurovascular bleeding in COVID-19 patients. This approach is effective and safe even in the subgroup of COVID-19 patients with coagulopathy.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.)
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy;
| | - Agostino Siciliano
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (A.S.)
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (M.V.); (F.P.); (A.C.)
| | - Pasquale Guerriero
- Radiology Unit, Santobono-Pausilipon Hospital, 80129 Naples, Italy;
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
| | | | - Rita Santoro
- Haemophilia and Thrombosis Center, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - MGJR Research Team
- Magna Graecia Junior Radiologists Research Team, 88100 Catanzaro, Italy;
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy;
- Scientific Committee of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), 00161 Rome, Italy
| | - Domenico Laganà
- Radiology Unit, Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
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Evrev D, Sekulovski M, Gulinac M, Dobrev H, Velikova T, Hadjidekov G. Retroperitoneal and abdominal bleeding in anticoagulated COVID-19 hospitalized patients: Case series and brief literature review. World J Clin Cases 2023; 11:1528-1548. [PMID: 36926396 PMCID: PMC10011983 DOI: 10.12998/wjcc.v11.i7.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/17/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Hospitalized and severely ill coronavirus disease 2019 (COVID-19) patients necessitate prophylactic or therapeutic anticoagulation to minimize the risk of thrombosis at different sites. Life-threatening bleeding complications include spontaneous iliopsoas hematoma, peritoneal bleeding, and extra-abdominal manifestations such as intracranial hemorrhage.
CASE SUMMARY Bleeding in the abdominal wall results in less severe complications than seen with iliopsoas hematoma or peritoneal bleeding. In our case series of 9 patients, we present retroperitoneal and abdominal bleeding complications following anticoagulation in hospitalized COVID-19 patients with severe acute respiratory syndrome coronavirus 2 pneumonia. Contrast-enhanced computed tomography (CE-CT) is the best imaging modality for assessing hematoma secondary to anticoagulation and determines the therapeutic approach, whether interventional, surgical, or conservative management.
CONCLUSION We present the role of CE-CT for rapid and precise localization of the bleeding site and prognostic counseling. Finally, we provide a brief review of the literature.
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Affiliation(s)
- Delian Evrev
- Department of Cardiac Surgery, University Hospital Lozenetz, Sofia 1407, Bulgaria
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Metodija Sekulovski
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Milena Gulinac
- Department of General and Clinical Pathology, Medical University of Plovdiv, Plovdiv 6000, Bulgaria
| | - Hristo Dobrev
- Department of Cardiac Surgery, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - George Hadjidekov
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Radiology, University Hospital “Lozenetz”, Kozyak 1 str., Sofia 1407, Bulgaria
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Increased reliability of CT-imaging signs of bleeding into soft tissue in patients with COVID-19 for planning transarterial embolization. Abdom Radiol (NY) 2023; 48:1164-1172. [PMID: 36692545 PMCID: PMC9872064 DOI: 10.1007/s00261-023-03810-7] [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: 10/30/2022] [Revised: 01/08/2023] [Accepted: 01/10/2023] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Spontaneous bleeding into the soft tissues of the abdominal and thoracic wall is described as complication of anticoagulant therapy. Computed tomography (CT) allows to detect the presence of extravasation of the contrast agent into a hematoma, which is indicated as a sign of ongoing bleeding. Other specific CT signs of such coagulopathic bleeding have been described earlier. AIM OF THE STUDY To evaluate the significance of specific coagulopathic CT signs for predicting the dynamics of spontaneous bleeding into soft tissues in patients with COVID-19. MATERIALS AND METHODS A retrospective study included 60 patients with COVID-19 with spontaneous bleeding into soft tissues and extravasation of a contrast agent on CT. In addition to extravasation, a "hematocrit effect" was detected in 43 patients on CT. Of these, 39 had extravasation in the form of a "signal flare." All patients underwent transarterial catheter angiography (TCA). To assess the prognostic value of CT signs, the results of CT and TCA compared. The absence of extravasation on the TCA more often corresponded to stopped bleeding. RESULTS Extravasation on TCA found in 27 (45%) patients. The presence of the "hematocrit effect" or the combination of this sign with the phenomenon of a "signal flare" on CT (n = 43) led to more frequent confirmation of extravasation on TCA than in their absence (n = 17): 23.5% vs. 53.4% (p = 0.028). CONCLUSION The presence of a fluid level and the phenomenon of a "signal flare" on CT in the structure of spontaneous hematomas of the soft tissues of the abdominal and thoracic wall in COVID-19 patients more often corresponded to ongoing bleeding on the TCA. The absence of coagulopathic CT signs more often corresponded to stopped bleeding.
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5
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Spontaneous retroperitoneal hematoma in patients with severe SARS-CoV-2 pneumonia. A systematic review. ANGIOLOGIA 2023. [DOI: 10.20960/angiologia.00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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Zeng W, Zhou X, Zhu J, Li J, Weng Y. Iliopsoas hematoma secondary to small needle scalpel for the treatment of nonspecific low back pain: A case report. Medicine (Baltimore) 2022; 101:e31975. [PMID: 36401461 PMCID: PMC9678515 DOI: 10.1097/md.0000000000031975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Nonspecific low back pain (NSLBP) is one of the most common symptoms which can happen all ages and it accounts for the majority of low back pain (LBP). Current clinical studies have shown that rest, physical therapy, acupuncture (including small needle scalpel) and non-steroidal antiinflammatory drugs are effective treatments for NSLBP. However, the safety of small needle scalpel for treatment of NSLBP was reported rarely. PATIENT CONCERNS A 63-year-old female patient was referred to the emergency department for right lower back pain, right lower quadrant ache, weakness of flexion right hip joints and worsening pain with walking after the treatment of small needle scalpel, which was performed by a rural doctor; the symptoms had been lasting for 9 hours. DIAGNOSIS She was diagnosed with traumatic iliopsoas hematoma because she experienced increased back pain after accepting small needle scalpel. Clopidogrel was stopped and the patient did not received a blood transfusion and just monitored Blood routine examination, liver and function, coagulation function after admission. INTERVENTIONS She had rest in bed absolutely for 3 days after admission. On the fourth day, she restarted taking Clopidogrel 75 mg every day and has gradually increased time for ambulation. She was discharged home and was ambulating with the help of a walking frame on day 7 and her follow-up abdominal CT scan on day 11 revealed reduced slightly hematoma. She was treated with rest, and showed an gradual recovery in approximately 3 weeks. OUTCOMES At day 85, the patient's LBP symptoms had completely disappeared and the result of liver function, renal function, coagulation function, blood routine was normal. CONCLUSION Small needle scalpel is a form of acupuncture. In China, small needle scalpel therapy has been used to treat various kinds of chronic pain. Anticoagulation therapy is a risk for bleeding, and patients who used Clopidogrel prepare to adopting small needle scalpel needs to be very cautious.
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Affiliation(s)
- Wu Zeng
- Suichang County People’s Hospital, SuiChang, ZheJiang, China
- *Correspondence: Wu Zeng, Suichang County People’s Hospital, SuiChang, ZheJiang, China (e-mail: )
| | - XiaoMing Zhou
- Suichang County People’s Hospital, SuiChang, ZheJiang, China
| | - JunFeng Zhu
- Suichang County People’s Hospital, SuiChang, ZheJiang, China
| | - Jun Li
- Suichang County People’s Hospital, SuiChang, ZheJiang, China
| | - YongYong Weng
- Suichang County People’s Hospital, SuiChang, ZheJiang, China
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Park YM, Yoo JR, Chang WB. Multiple Surgical Treatments for Recurrent Retroperitoneal Hemorrhage in a COVID-19 Patient with Respiratory Failure on Extracorporeal Membrane Oxygenation. JOURNAL OF ACUTE CARE SURGERY 2022. [DOI: 10.17479/jacs.2022.12.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Extracorporeal membrane oxygenation (ECMO) may be required in patients with corona virus disease-19 (COVID-19) and respiratory failure. Anticoagulation is the standard treatment to prevent complications of ECMO and COVID-19 coagulopathy, however, there is a risk of bleeding. Some patients with retroperitoneal hemorrhage (RPH) have been treated with angiography-embolization. We report on a patient with COVID-19 on ECMO who underwent multiple operations (×5) for recurrent RPH. A 46-year-old man was admitted with COVID-19 pneumonia. ECMO with anticoagulation therapy was initiated. The patient developed RPH, caused by external compression of the inferior vena cava interrupting the ECMO inflow, and surgical hematoma evacuation was performed, with no obvious bleeding focus during the multiple surgeries. Following the patient’s recovery, a follow-up computed tomography scan showed the hematoma had been resolved, but there was a dilemma regarding anticoagulation. Lowering the threshold for surgical treatment, enabled treatment of a patient with serious RPH.
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8
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Pourabhari Langroudi A, Shokri Varniab Z, Amouei M, Pak N, Khosravi B, Mirsharifi A, Radmard AR. Findings of Abdominal Imaging in Patients with COVID-19 - Part 1: Hollow Organs. Middle East J Dig Dis 2022; 14:278-286. [PMID: 36619269 PMCID: PMC9489432 DOI: 10.34172/mejdd.2022.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
Since COVID-19 has spread worldwide, the role of imaging for early detection of the disease has become more prominent. Abdominal symptoms in COVID-19 are common in addition to respiratory manifestations. This review collected the available data about abdominal computed tomography (CT) and ultrasonography indications in hollow abdominal organs in patients with COVID-19 and their findings. Since abdominal imaging is less frequently used in COVID-19, there is limited information about the gastrointestinal findings. The most common indications for abdominal CT in patients with COVID-19 were abdominal pain and sepsis. Bowel wall thickening and fluid-filled colon were the most common findings in abdominal imaging. Acute mesenteric ischemia (AMI) was one of the COVID-19 presentations secondary to coagulation dysfunction. AMI manifests with sudden abdominal pain associated with high morbidity and mortality in admitted patients; therefore, CT angiography should be considered for early diagnosis of AMI. Ultrasonography is a practical modality because of its availability, safety, rapidity, and ability to be used at the bedside. Clinicians and radiologists should be alert to indications and findings of abdominal imaging modalities in COVID-19 to diagnose the disease and its potentially serious complications promptly.
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Affiliation(s)
| | - Zahra Shokri Varniab
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrnam Amouei
- Assistant Professor, Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Pak
- Associate Professor, Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Bardia Khosravi
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Mirsharifi
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Associate Professor, Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author: Amir Reza Radmard, MD Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Shariati Hospital, 14117, North Kargar St., Tehran, Iran Tel: +98 21 84902178 Fax:+98 21 82415400 ,
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Khalighi E, Marzban-Rad S, Taheri HR. Acute Progressive retro-peritoneal hematoma in COVID19 patients with sub cutaneous ecchymosis. Ann Med Surg (Lond) 2022; 79:104107. [PMID: 35784949 PMCID: PMC9238019 DOI: 10.1016/j.amsu.2022.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction and importance: COVID19 is a multifunction disease where hematological disorders are reported. Coagulopathy is seen in these patients, indicated by thromboembolic events. Case presentation We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body and retroperitoneal hematoma in the posterior wall of the abdomen and chest. Clinical discussion Increased INR and bleeding and ecchymosis in Corona patients require discontinuation of anticoagulants and, FFP, essential and tri amino injections are needed. Conclusions Diagnosis and management of hematoma is important to avoid fatality. Global upsurge in COVID19 cases has been marked with systemic manifestations. We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions. We present COVID19 patients who were treated with anticoagulants and were seen to be presented with retroperitoneal hematoma.
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Affiliation(s)
- Ebrahim Khalighi
- Department of Anesthesiology, School of Allied Medical Sciences, Shahid Mostafa Khomaeini Hospital, Ilam University of Medical sciences, Ilam, Iran
| | - Saeid Marzban-Rad
- Department of Surgery, Imam-Reza Hospital, Aja University of Medical Sciences, Tehran, Iran
- Corresponding author.
| | - Hamid Reza Taheri
- Department of Surgery, School of Medicine, Shahed University, Tehran, Iran
- Corresponding author.
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Dubovský M, Hajská M, Panyko A, Vician M. Severe Retroperitoneal Hemorrhage in a COVID-19 Patient on a Therapeutic Dose of Low Molecular Weight Heparin: A Case Report. Cureus 2022; 14:e26275. [PMID: 35898364 PMCID: PMC9308901 DOI: 10.7759/cureus.26275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/12/2022] Open
Abstract
Extensive drug treatment for coronavirus disease 2019 (COVID-19) includes low molecular weight heparin (LMWH). At therapeutic doses of LMWH, there is an increased risk of bleeding complications. Spontaneous, non-traumatic bleeding into the retroperitoneum is a life-threatening condition that can progress very rapidly. We describe a complication of COVID-19 bronchopneumonia treatment in which a patient developed a shock condition caused by non-traumatic bleeding into the retroperitoneum and abdominal wall due to LMWH overdose. The patient was operated on under difficult conditions - in biosafety level 3 (BSL-3). This case is exceptionally fascinating and informative. Nowadays, it is essential to point out possible complications associated with the treatment of COVID-19. Based on this report, we emphasize the need for careful LMWH dosing and quick and accurate diagnosis. Surgeons should maintain a higher index of suspicion for spontaneous bleeding in non-specific abdominal pain patients with COVID-19 or patients receiving therapeutic doses of LMWH.
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11
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Marzban-Rad S, Bahmani S, Kazemi A, Taheri HR. Acute retroperitoneal hematoma following severe Covid-19 and the use of anticoagulants. Ann Med Surg (Lond) 2022; 78:103909. [PMID: 35693103 PMCID: PMC9173825 DOI: 10.1016/j.amsu.2022.103909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction and Importance: Severe COVID19 patients under anticoagulant therapy are at the risk of developing hematoma. Case presentation We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body and retroperitoneal hematoma in the posterior wall of the abdomen and chest. Clinical discussion Cases of hematoma with severe COVID19 patients under anticoagulant therapy are reported in several case studies, particularly in geriatric population with the previous history of blood and/or cardiac disorders. Conclusion These patients should be carefully monitored for hematomas by skilled nurse and practitioner and timely treated and monitored. - Global upsurge in COVID19 cases has been marked with systemic manifestations. Clinical studies have indicated thromboembolic events and vascular injuries in COVID19 patients. We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body. Alterations in biochemical parameters should also be monitored closely.
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Affiliation(s)
- Saeid Marzban-Rad
- Department of Surgery, Imam-Reza Hospital, Aja University of Tehran Medical Sciences, Tehran, Iran
| | - Sahar Bahmani
- Zist Takhmir Pharmaceutical Company, Tehran University of Medical Sciences, Tehran, Iran
| | - Amenehsadat Kazemi
- Department of Psychology, Faculty of Medical, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hamid Reza Taheri
- Department of Surgery, School of Medicine, Shahed University, Tehran, Iran
- Corresponding author.
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12
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Yoshioka T, Daizumoto K, Tada K, Mima M, Kagawa K, Fukawa T, Yamaguchi K, Takahashi M, Nishioka Y, Kanayama H. Retroperitoneal hemorrhage in a patient with coronavirus disease 2019 (COVID-19):A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:148-151. [PMID: 35466138 DOI: 10.2152/jmi.69.148] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Early prophylactic administration of anticoagulants is recommended in patients with coronavirus disease 2019 (COVID-19). A case of retroperitoneal hemorrhage during inpatient treatment for COVID-19 is reported. CASE PRESENTATION A 69-year-old man was diagnosed with COVID-19 6 days after symptom onset. After admission for difficulty of breathing, he was treated with steroid pulse therapy, remdesivir, and heparin sodium. On day 16 after admission, his hemoglobin and blood pressure dropped. Computed tomography showed a left retroperitoneal hematoma and multiple areas of extravasation in bilateral iliopsoas muscles. Anticoagulation therapy was stopped, and blood transfusion therapy was chosen by considering poor general condition caused by severe pneumonia. On day 19, the hemoglobin and blood pressure improved, and blood transfusion was stopped. However, he died on day 25 due to pneumonia. CONCLUSION When retroperitoneal hemorrhage occurs as a complication of COVID-19, appropriate treatment decision, transcatheter arterial embolization or conservative treatment, should be chosen based on patient's condition. J. Med. Invest. 69 : 148-151, February, 2022.
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Affiliation(s)
- Takuya Yoshioka
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kouki Tada
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masato Mima
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kozo Kagawa
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Hiroomi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
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López-Martínez L, Molina-Nuevo JD, Pedrosa-Jiménez MJ, Juliá-Mollá E. Spontaneous Haematomas in Anticoagulated Covid-19 Patients: Diagnosis and Treatment by Embolization. Cardiovasc Intervent Radiol 2022; 45:1001-1006. [PMID: 35088137 PMCID: PMC8794630 DOI: 10.1007/s00270-021-03049-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the safety and efficacy of embolization for spontaneous bleeding in anticoagulated patients with COVID-19. MATERIAL AND METHODS Single center retrospective study in 9 patients with COVID-19 who experienced bleeding complications following anticoagulation. The study included 8 men and 1 woman aged from 48 to 80 years (mean 69.7 years), who had a total of 10 soft tissue haematomas: 1 in the thigh, 1 in the anterior abdominal wall, 6 retroperitoneal and 2 thoracic haematomas. All patients were referenced for vascular embolization, mostly with Onyx-18. RESULTS A total of 10 haematomas were embolized in 9 patients. Technical success was achieved in all patients. No complications or adverse events were noted. One patient required percutaneous drainage of an infected haematoma 88 days after embolization. The mean hemoglobin level before embolization was 8,64 mg/dL and increased to 9,08 mg/dL after embolization (p = 0,3). After embolization all patients recovered haemodynamic stability and blood pressure levels improved. Seven patients resumed anticoagulation therapy after embolization. There were no recurrences or new bleedings in all treated patients. No patients required any additional invasive therapies or surgery. Mean intensive unit care and hospital stay was 6.7 and 35.2 days, respectively. All patients were discharged and were well at follow-up clinic visits 2-7 months after embolization. Seven patients performed a control CT scan 1-6 months after embolization, showing complete resolution of the haematoma. CONCLUSION Embolization is safe and effective to treat spontaneous haematomas in anticoagulated patients with COVID-19, allowing to resume anticoagulation therapy. Level of evidence IV Level 4, case-series.
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Affiliation(s)
- Lorena López-Martínez
- Vascular and Interventional Radiology Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - Juan D Molina-Nuevo
- Vascular and Interventional Radiology Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - María J Pedrosa-Jiménez
- Vascular and Interventional Radiology Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Enrique Juliá-Mollá
- Vascular and Interventional Radiology Unit, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
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14
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Vascular findings in CTA body and extremity of critically ill COVID-19 patients: commonly encountered vascular complications with review of literature. Emerg Radiol 2022; 29:263-279. [PMID: 35064373 PMCID: PMC8782694 DOI: 10.1007/s10140-021-02013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/21/2021] [Indexed: 10/28/2022]
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15
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Masaki S, Takahashi T, Sahara T, Endo R, Obana M. A Case of Iliopsoas Hematoma Caused by Prophylactic Anticoagulation against COVID-19. Prog Rehabil Med 2022; 7:20220004. [PMID: 35178482 PMCID: PMC8811153 DOI: 10.2490/prm.20220004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 12/28/2021] [Indexed: 11/09/2022] Open
Abstract
Background: Case: Discussion:
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Affiliation(s)
- Shoichi Masaki
- Department of Rehabilitation Medicine, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Tadashi Takahashi
- Department of Rehabilitation Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Toshinori Sahara
- Department of Infectious Diseases, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Ryo Endo
- Department of Rehabilitation Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
| | - Masayoshi Obana
- Department of Rehabilitation Medicine, Tokyo Metropolitan Health and Hospitals Corporation Ebara Hospital, Tokyo, Japan
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16
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Tavone AM, Giuga G, Attanasio A, Petroni G, Mauriello S, Cordova F, Marella GL. A Rapid Fatal Outcome of Iliopsoas Hematoma: Clinical and Autopsy Findings. J Investig Med High Impact Case Rep 2022; 10:23247096221111760. [PMID: 35848071 PMCID: PMC9290084 DOI: 10.1177/23247096221111760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A case of massive muscular bleeding of iliopsoas resulting in lethal exsanguination is presented. The intramuscular bleeding occurred spontaneously in an old man with heart failure, presented to the emergency department after the acute onset of shortness of breath, and treated with therapeutic doses of antiplatelets and heparin to prevent thrombosis. On the sixth day of recovery, pain in the left lumbar region develops while there was a decrease in hemoglobin level. Computed tomography (CT) scan revealed a 10 × 3 cm hematoma of the left iliac muscle. The treatment was immediately stopped, but within 6 hours, the death was confirmed. The autopsy revealed that the hematoma, and its increased size since the latest imaging assessment, was the leading cause of death. Particularly in older patients with comorbidity, even in those with clotting parameters in the therapeutic range, the potential for fatal result of iliopsoas muscle bleeding should be considered. Identifying potential patience with increased risk of this complication could be important, especially in pandemic time of COVID-19, when the use of anticoagulant therapy—both for treatment and for prevention of severe disease—has become massive and addressed also to people without previous and specific pathologies.
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Affiliation(s)
| | - Gabriele Giuga
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome (Italy)
| | | | - Giulia Petroni
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome (Italy)
| | - Silvestro Mauriello
- Department of Biomedicine and Prevention, University of Rome ‘Tor Vergata’, Rome (Italy)
| | | | - Gian Luca Marella
- Department of Surgical Science, University of Rome ‘Tor Vergata’, Rome (Italy)
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17
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Alavi-Naini R, Gorgani F, Rahmati Z, Pourdehghan S, Keikha M, Farzad Z. Spontaneous Multiple Haematomas in a Patient with Severe COVID-19 Fully Recovered with a Conservative Approach. Prague Med Rep 2021; 122:300-307. [PMID: 34924108 DOI: 10.14712/23362936.2021.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
A significant number of hospitalized patients with COVID-19 are prone to thromboembolic events including deep vein thrombosis, pulmonary embolism, cerebrovascular accident, and myocardial infarction. However, some COVID-19 patients have a higher risk of bleeding that is associated with an increased risk of mortality. We report a 71-year-old woman who was a confirmed case of COVID-19 admitted for pulmonary involvement and complicated acute renal failure. During hospitalization, she suffered from a sudden onset of severe pain in the lower left abdomen as well as a sudden drop in blood pressure and hemoglobin. Haematomas in the left rectus and obturator internus muscle were observed in abdominal and pelvic computed tomography scan. Signs of haemorrhage were also seen in the anterolateral aspect of the bladder with extension to the paracolic, subdiaphragmatic, perihepatic and, perisplenic spaces. The patient was totally recovered by a conservative approach. Bleeding tendency could be a serious complication, especially, in COVID-19 patients with complicated renal failure that receive heparin prophylaxis.
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Affiliation(s)
- Roya Alavi-Naini
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.
| | - Farzaneh Gorgani
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zohre Rahmati
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saemeh Pourdehghan
- Infectious Diseases and Tropical Medicine Research Center, Research Institute of Cellular and Molecular Sciences in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Maryam Keikha
- Department of Radiology, Children and Adolescents Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Farzad
- Medical Doctor, International Medical Graduate, Representative of the International Clinical Research Academy, Toronto, Canada
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18
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Life-Threatening Retroperitoneal Hematoma in a Patient with COVID-19. Case Rep Hematol 2021; 2021:8774010. [PMID: 34745669 PMCID: PMC8570906 DOI: 10.1155/2021/8774010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/17/2021] [Accepted: 10/27/2021] [Indexed: 12/13/2022] Open
Abstract
COVID-19 is a respiratory illness that affects the human body in many different ways. The disease carries both thrombotic and hemorrhagic complications, especially in those patients who are anticoagulated to prevent the thromboembolic manifestations. In this report, we discuss a case of retroperitoneal hemorrhage in a patient treated with therapeutic anticoagulation which ultimately led to the patient's death. The literature highlights the importance of anticoagulation because it reduces mortality in patients hospitalized with COVID-19. Although, more recent studies suggest that patients treated with therapeutic anticoagulation are at a higher risk of hemorrhage and increased mortality. Therefore, our case stresses the importance of active monitoring of these patients to detect any suspected case of hemorrhage early to reduce mortality. Overall, more research should be conducted to determine the optimal dosing of anticoagulation that balances safety and efficacy.
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19
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Yeoh WC, Lee KT, Zainul NH, Syed Alwi SB, Low LL. Spontaneous retroperitoneal hematoma: a rare bleeding occurrence in COVID-19. Oxf Med Case Reports 2021; 2021:omab081. [PMID: 34527254 PMCID: PMC8436278 DOI: 10.1093/omcr/omab081] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/28/2021] [Accepted: 07/27/2021] [Indexed: 12/25/2022] Open
Abstract
Emerging evidence suggest that COVID-19 is associated with hypercoagulability, predisposing patients to increase risk of thromboembolism. Anticoagulation is not without its risks of bleeding and decision to initiate anticoagulation should be carefully considered with close monitoring. Spontaneous retroperitoneal hematoma is a rare complication, and there are only a few documented reports implicating anticoagulant or antiplatelet agents as a potential cause. We report a 57-year-old gentleman with COVID-19 pneumonia who developed hypotension on Day 10 of illness while on prophylactic anticoagulation. Computed tomography scan of abdomen revealed a large right retroperitoneal and psoas muscle hematoma and he underwent surgical exploration to evacuate the hematoma. His condition improved and was discharged well. Although prophylactic anticoagulation may reduce thrombotic complications in severely ill COVID-19 patients, a high index of suspicion for rare bleeding complications should be maintained if patients become hemodynamically unstable. Early diagnosis and appropriate intervention may improve outcome and prevent mortality.
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Affiliation(s)
| | - Kee Tat Lee
- Medical Department, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Nadiah Hanim Zainul
- Infectious Disease Unit, Medical Department, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | | | - Lee Lee Low
- Infectious Disease Unit, Medical Department, Hospital Sultanah Bahiyah, Kedah, Malaysia
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20
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Multiple drugs. REACTIONS WEEKLY 2021. [PMCID: PMC8435098 DOI: 10.1007/s40278-021-02280-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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21
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Abate V, Casoria A, Rendina D, Muscariello R, Nuzzo V, Vargas M, Servillo G, Venetucci P, Conca P, Tufano A, Galletti F, Di Minno G. Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series. Semin Thromb Hemost 2021; 48:100-108. [PMID: 34388842 DOI: 10.1055/s-0041-1732370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Coagulation abnormalities, thrombosis, and endothelial dysfunction have been described in COVID-19 patients. Spontaneous muscle hematoma (SMH) is a rare complication in COVID-19. The aims of this study are to: (1) perform a systematic review of the literature to better define the clinical SMH characteristics, (2) describe the prevalence and the clinical characteristics of SMH in COVID-19 patients referring to a Department of Internal Medicine (IM) (Federico II University of Naples), a Department of Sub-Intensive Care Medicine (SIM) (Ospedale Del Mare), and a Department of Intensive Care Unit (ICU) (Federico II University). The systematic review was performed according to PRISMA criteria. The local prevalence of SMH in COVID-19 was evaluated retrospectively. The medical records of all COVID-19 patients referring to IM and ICU from March 11th, 2020, to February 28th, 2021 were examined for SMH occurrence. In our retrospective analysis, we describe 10 cases of COVID-19 patients with SMH not previously reported in literature, with a prevalence of 2.1%. The literature review, inclusive of our case series, describes a total of 50 SMHs in COVID-19 patients (57.4% males; mean age 68.8 ± 10.0 years). The SMH sites were ileo-psoas, vastus intermedius, gluteus, sternocleidomastoid, and pectoralis major muscles. Males developed SMH earlier than females (9.5 ± 7.8 vs. 17.1 ± 9.7 days). Ileo-psoas hematoma was more frequent in males (69.2 vs. 30.8%), while pectoralis major hematoma occurred only in females. The in-hospital mortality rate of SMH in COVID-19 patients was 32.4%. SMH is a rare but severe complication in COVID-19 hospitalized patients, associated with high mortality. A gender difference seems to be present in the clinical presentation of the disorder.
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Affiliation(s)
- Veronica Abate
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | | | - Vincenzo Nuzzo
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Pietro Venetucci
- Department of Morphological and Functional Diagnostics, Radiotherapy, Forensic Medicine, University of Naples "Federico II," Naples, Italy
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
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22
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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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23
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Zerbato V, Bozzato AM, Di Bella S, Giuffrè M, Martingano P, Di Giusto A, Battisti S, Cova MA, Luzzati R, Cavallaro MFM. Spontaneous psoas haematoma: a life-threatening complication of anticoagulation in COVID-19. A case series of four episodes. Infect Dis (Lond) 2021; 53:724-729. [PMID: 33939587 DOI: 10.1080/23744235.2021.1918347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Anticoagulant prophylaxis is part of the standard management of hospitalized COVID-19 patients. Despite adequate thromboprophylaxis, one-third of COVID-19 patients with pneumonia developed pulmonary embolism. This high rate of thrombotic complications has led to higher doses of anticoagulants according to clinical complexity (e.g. intensive care unit (ICU) patients) and D-dimer levels. On the other side of the coin, haemorrhagic complications are being increasingly reported. CASES PRESENTATION We herein report four cases of spontaneous psoas haematomas (SPH) among 548 patients hospitalized for SARS-CoV-2 pneumonia between March 2020 and January 2021 (incidence of 7.3 cases per 1000 patients). All patients had pneumonia, with age ranging between 62 and 83 years. All patients received anticoagulant therapy with low weight molecular heparin (100 U.I. anti-Xa/kg 2 times/d) from admission: in two cases, a diagnosis of pulmonary embolism was made. In another case, a thrombosis of left axillary and basilic veins was found, and only in one case anticoagulant therapy was started because of elevated levels of D-dimer. In all cases, signs of anaemia were detected and patients experienced low back or abdominal pain. The diagnosis of spontaneous psoas haematoma was made by computed tomography (CT) after a median of 12.5 d (9;16) from admission and 19.5 d (14.75; 24.25) from the beginning of COVID-19 symptoms. Half of these patients died from haemorrhagic shock. CONCLUSIONS Given the potential life-threatening of SPH and the possible subtle clinical presentation, we believe it is crucial to raise clinicians awareness of this complication among COVID-19 patients undergoing anticoagulants.
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Affiliation(s)
- Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital, Trieste, Italy
| | | | - Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Infectious Diseases Unit, Trieste University, Trieste, Italy
| | - Mauro Giuffrè
- Clinical Department of Medical, Surgical and Health Sciences, Liver Unit, Trieste University, Trieste, Italy
| | - Paola Martingano
- Department of Radiology, Trieste University Hospital, Trieste, Italy
| | - Anna Di Giusto
- Department of Radiology, Trieste University Hospital, Trieste, Italy
| | - Sofia Battisti
- Department of Radiology, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy.,Scientific Institute of Romagna for the Study and Treatment of Tumors, Meldola, Italy.,Department of Specialized Medicine Diagnostic and Experimental Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Infectious Diseases Unit, Trieste University, Trieste, Italy
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