COVID-19 and hemorrhagic complications: pectoral hematoma

BENAZZI, Dario; ANTONICELLI, Viviana; PRESCIUTTINI, Barbara; FORONI, Enrica; BELLINI, Massimo; SMURRA, Andrea; Bianco, Claudia Lo; Amato, Massimo

doi:10.23736/s2532-1285.21.00044-6

Cited by 7 publications

(5 citation statements)

References 15 publications

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“…8,13,26,32,34 Dohan and colleagues argued that the presence of active bleeding is related to a greater severity of the clinical picture. 32 As in some cases in our study, Benazzi et al reported pulmonary embolism in one of their two cases, 17 Dennison et al reported the case of a patient with splenic ischaemia, abdominal wall haemorrhage and mesenteric vessel infarction, 13 while concomitance of DVT and haemorrhage has been reported by other authors.…”

Section: Symptoms and Imagingsupporting

confidence: 75%

“…14,18 Among the risk factors for the development of bleeding in COVID-19 patients, contributing causes have been proposed, such as pronation manoeuvres, anticoagulant treatment, obesity, increased vascular fragility determined by the proinflammatory state, barotrauma from ventilation by C-PAP and cough with consequent increase in intra-abdominal pressure and arterial rupture. 17,19 Many of these risk factors coincide with those that have been documented in this article.…”

Section: Role Of Anticoagulation In Covid-19 Therapy and Risk Factors...supporting

confidence: 68%

“…5,6 During the COVID-19 pandemic, in addition to the pulmonary and neurological manifestations, the alteration of the coagulation pathway soon appeared significant, which represented the rationale for the use of heparin. 5,7,8,9,10,11,12,13,14,15,16 This alteration resulted both in the form of hypercoagulability 11,14,17 with expressions of a thromboembolic nature (e.g. PTE, DVT), whose mechanism is still necessary to investigate, 13 and in the form of haemorrhagic diathesis with depletion of coagulation factors, thrombocytopenia and hyperfibrinolysis.…”

Section: Role Of Anticoagulation In Covid-19 Therapy and Risk Factors...mentioning

confidence: 99%

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Spontaneous bleeding in COVID-19: A retrospective experience of an Italian COVID-19 hospital

Trentadue¹,

Calligaro²,

Lazzarini

et al. 2022

S. Afr. j. radiol.

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Background: Haemorrhages in coronavirus disease 2019 (COVID-19) patients require proper knowledge and management.Objectives: To highlight the characteristics of haemorrhages in patients with COVID-19 infection.Method: A retrospective study examined CT scans performed over a 13-month period in patients hospitalised with COVID-19 infection to determine those who developed spontaneous bleeding. The authors also investigated correlations between the bleeding events and the patients’ characteristics.Results: Haemorrhages occurred in 2.22% (31/1396) of patients hospitalised with COVID-19 infection (7.88%, 19/241 in the intensive care unit). Bleeding, major in most cases, occurred in anticoagulated patients, especially males with multiple comorbidities, aged between 60 and 79 years and mainly appeared in a single anatomical region (especially retroperitoneal), with the most voluminous in the chest wall. The complication was diagnosed on average 16.7 days after admission and occurred predominantly in critically ill patients undergoing invasive ventilation and pronation-supination cycles. In just under half of the cases, the haematomas were active, and in these cases, mainly with a single contrast blush and with earlier onset after the start of anticoagulation than in non-active bleeding. Major bleeding was also earlier in the presence of multiple morbidity. The vast majority of patients were treated conservatively and survived.Conclusion: At COVID-19 hospital centres, it is advisable that there is knowledge of such a complication for which CT imaging is essential for diagnosis and proper management. Although some authors have expressed doubts about anticoagulant treatment in patients with COVID-19, the bleeding complication in this study did not significantly affect the outcome.Contribution: Spontaneous haemorrhage did not significantly affect the outcome in this series.

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Section: Symptoms and Imagingsupporting

confidence: 75%

Section: Role Of Anticoagulation In Covid-19 Therapy and Risk Factors...supporting

confidence: 68%

Section: Role Of Anticoagulation In Covid-19 Therapy and Risk Factors...mentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous bleeding in COVID-19: A retrospective experience of an Italian COVID-19 hospital

Trentadue¹,

Calligaro²,

Lazzarini

et al. 2022

S. Afr. j. radiol.

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“…In critically ill patients, a higher incidence of disseminated intravascular coagulopathy, and/hemorrhagic complications have been reported [8,10,24,25]. Even rare cases with subcutaneous hematomas developed during the acute phase of the disease, related mostly to the administration of anticoagulants have been described [11,17,[26][27][28]. While thrombotic events occurred early, in the first week of the acute illness, it was observed that hematomas appeared after 2-3 weeks, mostly in elderly people with comorbidities [27,28].…”

Section: Discussionmentioning

confidence: 99%

Spontaneous Hematomas and Deep Vein Thrombosis during the Recovery from a SARS-CoV-2 Infection: Case Report and Literature Review

Tudoran

Abu-Awwad

et al. 2022

Medicina

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Background: The frequent occurrence of thromboembolic events in patients infected with the severe acute respiratory syndrome CoV2 (SARS-CoV-2) virus is a well-recognized fact in the medical literature, but less data is available about possible hemorrhagic incidents. Methods: We report the case of a 76-year-old patient who suffered from a mild COVID-19 infection in September 2021 and after four weeks, experienced a completely spontaneous popliteal hematoma followed by deep vein thrombosis (DVT). Therapy with low molecular weight heparins (LMWH) was started, but subsequently, the patient developed a massive sub-pectoral and calf hematoma leading to moderate post-hemorrhagic anemia and acute kidney injury. This patient was treated completely conservatively. Conclusions: Considering the continuous spread of the infection with various, continuously evolving strains of this virus and the extended use of LWMH in clinical practice, such cases were seldom described in the medical literature, but should be considered as a potential cause for hemorrhagic events.

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“…We have already described two of these clinical cases in our previous publication. 15 In this new article, we describe a third similar case: she was obese as the other two women, and she had a pectoral hematoma, a problem that was very rare before this pandemic. We have also reviewed clinical reports from 2020 to 2022 about hemorrhagic complications during COVID-19 (PubMed and online reviewed publications).…”

Section: Introductionmentioning

confidence: 92%

Hemorrhagic complications in COVID-19: three women with pectoral hematoma and a review

et al. 2023

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Patients hospitalized with COVID-19 pneumonia are at risk for thrombotic complications. At the same time, they need respiratory support, and they frequently require nursing in a prone position. From March to May 2020, 57 patients with acute respiratory distress syndrome were admitted to our departments. Our therapeutic protocol included anticoagulant treatment and prone positioning. We have treated three obese women affected by severe pneumonia and pectoral hematoma with post-hemorrhagic anemia. We have already described two of these cases in our previous publication; in this new article, we describe a third similar case and review clinical reports from 2020 to 2022 about hemorrhagic complications during COVID-19. Reports confirm that pectoral hematomas and bleeding in unusual sites are a complication of COVID-19. Pectoral hematomas are likely to be related to COVID-19 severity, heparin dosage, and traumatism due to cough and pronosupination.

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COVID-19 and hemorrhagic complications: pectoral hematoma

Cited by 7 publications

References 15 publications

Spontaneous bleeding in COVID-19: A retrospective experience of an Italian COVID-19 hospital

Spontaneous bleeding in COVID-19: A retrospective experience of an Italian COVID-19 hospital

Spontaneous Hematomas and Deep Vein Thrombosis during the Recovery from a SARS-CoV-2 Infection: Case Report and Literature Review

Hemorrhagic complications in COVID-19: three women with pectoral hematoma and a review

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