Bleeding into the Abdominal and Ilio-Lumbar Muscles—A Rare Complication in the Course of COVID-19: Analysis of Four Cases and a Literature Review

Mackiewicz−Milewska, Magdalena; Sakwińska, Katarzyna; Cisowska-Adamiak, Małgorzata; Szymkuć-Bukowska, Iwona; Ratuszek-Sadowska, Dorota; Mackiewicz‐Nartowicz, Hanna

doi:10.3390/jcm11164712

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Also, in the study by Avruscio et al [5], including patients with COVID-19 admitted to both medical wards and ICU, who underwent systematic screening for VTE during their hospital stay, a high frequency of VTE (27% and 76%, respectively) was observed, despite standard-dose or high-dose thromboprophylaxis in all patients. The optimal dose of anticoagulant prophylaxis in patients with COVID-19, which would be safe and ensure the lowest rate of hemorrhagic complications, that affect approximately 2-7% of patients, is currently being discussed [33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism in Patients Hospitalized for COVID-19 in a Non-Intensive Care Unit

Mackiewicz-Milewska,

Cisowska-Adamiak,

Pyskir

et al. 2024

JCM

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Coronavirus Disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may contribute to venous thromboembolism (VTE) with adverse effects on the course of COVID-19. The purpose of this study was to investigate an incidence and risk factors for VTE in patients hospitalized for COVID-19 in a non-intensive care unit (non-ICU). Consecutive adult patients with COVID-19 hospitalized from November 2021 to March 2022 in the isolation non-ICU at our center were included in the study. Incidence of VTE including pulmonary embolism (PE) and deep vein thrombosis (DVT), clinical characteristics, and D-dimer plasma levels during the hospitalization were retrospectively evaluated. Among the 181 patients (aged 68.8 ± 16.2 years, 44% females, 39% Delta SARS-CoV-2 variant, 61% Omicron SARS-CoV-2 variant), VTE occurred in 29 patients (VTE group, 16% of the entire cohort). Of them, PE and DVT were diagnosed in 15 (8.3% of the entire cohort) and 14 (7.7%) patients, respectively. No significant differences in clinical characteristics were observed between the VTE and non-VTE groups. On admission, median D-dimer was elevated in both groups, more for VTE group (1549 ng/mL in VTE vs. 1111 ng/mL in non-VTE, p = 0.09). Median maximum D-dimer was higher in the VTE than in the non-VTE group (5724 ng/mL vs. 2200 ng/mL, p < 0.005). In the univariate analysis, systemic arterial hypertension and the need for oxygen therapy were predictors of VTE during hospitalization for COVID-19 (odds ratio 2.59 and 2.43, respectively, p < 0.05). No significant associations were found between VTE risk and other analyzed factors; however, VTE was more likely to occur in patients with a history of VTE, neurological disorders, chronic pulmonary or kidney disease, atrial fibrillation, obesity, and Delta variant infection. Thromboprophylaxis (83.4% of the entire cohort) and anticoagulant treatment (16.6%) were not associated with a decreased VTE risk. The incidence of VTE in patients hospitalized in non-ICU for COVID-19 was high despite the common use of thromboprophylaxis or anticoagulant treatment. A diagnosis of arterial hypertension and the need for oxygen therapy were associated with an increased VTE risk. Continuous D-dimer monitoring is required for the early detection of VTE.

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Section: Discussionmentioning

confidence: 99%

Venous Thromboembolism in Patients Hospitalized for COVID-19 in a Non-Intensive Care Unit

Mackiewicz-Milewska,

Cisowska-Adamiak,

Pyskir

et al. 2024

JCM

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“…The most commonly affected area is the rectus sheath [ 15 , 16 , 17 , 18 ]. Hematomas within the lumbar and iliac muscles have also been described, which may lead to hemodynamic instability and could potentially be fatal [ 19 , 20 ]. SMHs can be divided into small ones, which are clinically insignificant and most often remain contained in the fascia—mainly treated conservatively—and large ones that can cause hemodynamic instability and may be life threatening.…”

Section: Discussionmentioning

confidence: 99%

“…The main symptoms of SMH are pain at the site of SMH formation, emphasized by numerous authors, and, depending on the location and size of the swelling in a given area, a decrease in hemoglobin and hemodynamic instability [ 18 , 19 , 20 ]. Intramuscular hematomas in patients after SCI are rarely reported.…”

Section: Discussionmentioning

confidence: 99%

Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)—A Rare Complication: Description of Seven Cases and a Literature Analysis

et al. 2023

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Spinal cord injuries (SCIs) are associated with a high risk of thromboembolic complications (VTE), despite the use of antithrombotic prophylaxis in the form of low-molecular-weight heparin (LMWH). The occurrence of VTE requires, as in other diseases, full-dose antithrombotic treatment. Herein, we describe seven cases of soft tissue hemorrhagic complications in the form of spontaneous intramuscular hematomas (SMHs) in patients after SCI undergoing rehabilitation. Four patients received anticoagulant therapy due to previously diagnosed deep vein thrombosis (DVT), and three patients received anticoagulant prophylaxis. None of the patients had a significant injury immediately before the hematoma appeared, and the only symptom was a sudden swelling of the limb without accompanying pain. The hematomas in all patients were treated conservatively. In three patients, significant decreases in hemoglobin were observed; in one patient, a blood transfusion was required for this reason. In all patients treated via anticoagulation, the anticoagulation treatment was modified at the time of diagnosis of the hematoma; in three patients, oral anticoagulants were changed to LMWH in a therapeutic dose, while in one patient, anticoagulant treatment was completely discontinued. Conclusions: Intramuscular hematomas are rare complications after SCI. Each sudden swelling of a limb requires ultrasound-based diagnostics. At the time of diagnosis of a hematoma, the level of hemoglobin and the size of the hematoma should be monitored. The treatment or anticoagulation prophylaxis should be modified if necessary.

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“…Bleeding in patients with COVID-19 can be the result of pre-existing risks factors, antithrombotic drugs and a massive immune response to the virus, [ 51 ]. A common bleeding complication is abdominal hematomas, usually of the Iliopsoas and rectus abdominis muscle [ 51 , 52 ]. The role of a CT scan is major in both the diagnosis and treatment of these entities.…”

Section: Methodsmentioning

confidence: 99%

Gastrointestinal Imaging Findings in the Era of COVID-19: A Pictorial Review

Mavropoulou,

Psoma,

Papachristodoulou

et al. 2023

Medicina

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The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations, gastrointestinal tract-related symptoms suchas nausea, diarrhea, abdominal distention and pain have been observed in patients, as a consequence of the binding of SARS-CoV-19 to Angiotensin-converting Enzyme 2 (ACE2) receptors in the gastrointestinal (GI) tract. The early recognition ofspecific imaging features, including hepatobiliary involvement, pancreatic involvement, development of solid organ infarcts, ischemic bowel changes and vascular occlusion, plays a key role through the course of the disease. Also, suspicious symptoms, especially in critically ill patients with clinical and biochemical markers of hypovolemia, necessitate timely imaging for bleeding complications. The aim of this pictorial review is to illustrate the spectrum of the GIimaging findings in patients with COVID-19. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients.

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Bleeding into the Abdominal and Ilio-Lumbar Muscles—A Rare Complication in the Course of COVID-19: Analysis of Four Cases and a Literature Review

Cited by 6 publications

References 16 publications

Venous Thromboembolism in Patients Hospitalized for COVID-19 in a Non-Intensive Care Unit

Venous Thromboembolism in Patients Hospitalized for COVID-19 in a Non-Intensive Care Unit

Intramuscular Hematomas in Patients Receiving Prophylaxis or Anticoagulant Treatment after Spinal Cord Injury (SCI)—A Rare Complication: Description of Seven Cases and a Literature Analysis

Gastrointestinal Imaging Findings in the Era of COVID-19: A Pictorial Review

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