Aim of the study. To evaluate the risk factors for the occurrence of intramuscular hematomas in patients with severe coronavirus infection receiving anticoagulant therapy.Materials and methods. Intramuscular hematomas in five patients with severe COVID-19 disease are reported in the paper. The criteria for selecting patients for the study included respiratory distress requiring oxygen, radiographic signs of severe pneumonia, anticoagulant therapy using low molecular weight heparin (LMWH), and spontaneous intramuscular hematoma. Clinical manifestations, blood coagulation results, conservative and surgical management were analyzed.Results. Standard regimen anticoagulation therapy in patients with coronavirus infection requires vigilance because of a risk of development of hemorrhagic complications.Сonclusion. When assessing a patient with hematomas, an emphasis should be given to examination of patients and changes in hemoglobin and hematocrit levels. Best strategy of anticoagulant therapy for patients with coronavirus infection and high risk of VTE, as well as optimal laboratory monitoring during LMWH administration are yet to be explored.

Objective: Long-standing gastroesophageal reflux disease is the most common cause of a cicatricial stricture of the esophagus. The treatment of this pathology involves a wide range of methods including conservative and surgical options. Surgeons can encounter technical difficulties in case of concomitant neck and chest pathology.Clinical case: We report a case of a decompensated cicatricial stricture of the esophagus with concomitant paraesophageal hiatal hernia, refractory gastroesophageal reflux disease, and nontoxic multinodular goiter (166.9 cm3). Selecting the optimal management for such patients is often a challenge. Staged treatment significantly improves postoperative quality of life, but the increased length of hospital stay can negatively impact patient compliance.

Purpose: To demonstrate the capabilities of a complex of multiparametric ultrasound and MRI with intravenous contrast in the detection and characterization of atypical hepatocellular carcinoma with the example of a clinical case of a middle-aged patient without liver cirrhosis.Material and methods: Comprehensive study of medical history, outpatient records, results of clinical, laboratory, instrumental and morphological methods with independent retrospective analysis of the histological preparation of focal liver lesion.Results: Diagnostic search data are presented in a 48-year-old patient with hepatocellular carcinoma without signs of liver cirrhosis. The diagnosis required 1.5 months of examination in gastroenterological department, repeated review of the histological preparation by morphologists. The disease debuted with weakness after physical exertion, which was noted during a planned multiparameter abdomen ultrasound examination. During the study, multiple focal formations with uneven fuzzy contours, an inhomogeneous structure were visualized. Stiffness of the parenchyma in focal liver lesion is 108.29 kPa due to 2D-SWE. Further tactics consisted of hospitalization with further laboratory examination and abdomen MRI with intravenous contrast enhancement. Considering the results of instrumental examination, the patient was prescribed a puncture aspiration biopsy of focal liver lesion under ultrasound control followed by morphological verification.Conclusion: The presented clinical observation demonstrates the need of use an integrated approach in instrumental imaging methods in the diagnosis of atypical hepatocellular carcinoma.