Giant Retroperitoneal Hematoma During Extracorporeal Membrane Oxygenation in a Patient With Coronavirus Disease-2019 Pneumonia

Guo, Shaohui; Zhu, Shengmei

doi:10.1053/j.jvca.2020.05.039

Cited by 15 publications

(11 citation statements)

References 7 publications

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“…A previous report described a case of COVID-19 with simultaneous deep vein thrombosis and retroperitoneal hemorrhage who was not receiving anticoagulation [ 11 ]. A similar case of retroperitoneal hemorrhage was reported in a patient 1 week after starting extracorporeal membrane oxygenation (ECMO) [ 9 ]. Winegarden et al reported a COVID-19-infected female with retroperitoneal hemorrhage who presented with back and leg pain during antithrombotic treatment [ 12 ].…”

Section: Discussionmentioning

confidence: 67%

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Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients

Mahboubi-Fooladi

Arabi

Khazaei

et al. 2021

SN Compr. Clin. Med.

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Since coronavirus disease 2019 (COVID-19) is associated with a hypercoagulable state, especially in critical patients, anticoagulation is used for thromboprophylaxis. Hemorrhagic complications, even uncommon ones such as retroperitoneal hemorrhage, can occur following anticoagulant administration. We present 5 patients with COVID-19 whose clinical course was complicated by spontaneous retroperitoneal hemorrhage. The patients were initially presented with respiratory manifestations of the infection. There was no history or evidence suggestive for traumatic injury. After hospitalization, the patients received supplemental oxygen, antibiotics, enoxaparin or heparin, interferon beta-1b (in three patients), and anticoagulation with subcutaneous injection of enoxaparin (three patients) or heparin (two patients). During the course of hospitalization, the patients showed sudden-onset abdominal pain (three cases), hypotension (three cases), and an acute drop in hemoglobin level. CT scan of the abdomen and pelvis revealed retroperitoneal hemorrhage. For one patient, owing to unstable vital signs and an expanding hematoma, surgical intervention was performed. Others were managed conservatively with discontinuation of anticoagulants, intravenous (IV) fluid resuscitation, and packed red blood cells transfusion. Three patients died due to worsening of the infection and respiratory failure. Retroperitoneal hemorrhage could be a potential complication in COVID-19 patients receiving anticoagulation. Careful monitoring of the vital signs and blood tests like hemoglobin level of such patients is essential.

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Section: Discussionmentioning

confidence: 67%

“…On the other hand, various hemorrhagic conditions have been reported in COVID-19 patients. Recently, case reports have been published about the development of retroperitoneal hemorrhage in COVID-19 patients while receiving anticoagulation [ 6 – 8 ] or during extracorporeal membrane oxygenation [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients

Mahboubi-Fooladi

Arabi

Khazaei

et al. 2021

SN Compr. Clin. Med.

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“…5,6 The precise frequency of spontaneous IPH in COVID-19 patients remains unclear; however, eight case series have been reported (Table 1). [7][8][9][10][11][12][13] Several specific predisposing factors, including anticoagulation therapy, advanced age, and hemodialysis, are associated with developing spontaneous IPH. 5 Previous reports in addition to the current case series were consistent with this evidence.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Iliopsoas Hematoma during the Clinical Course of Severe COVID-19 in Two Male Patients

Nakamura

Ouchi

Miyagi

et al. 2021

The American Journal of Tropical Medicine and Hygiene

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Anticoagulation plays a major role in reducing the risk of systematic thrombosis in patients with severe COVID-19. Serious hemorrhagic complications, such as intracranial hemorrhage, have also been recognized. However, intra-abdominal hemorrhage is under-recognized because of its rare occurrence, despite high mortality. Here, we discuss two cases of spontaneous iliopsoas hematoma (IPH) likely caused by anticoagulants during the clinical course of COVID-19. We also explored published case reports to identify clinical characteristics of IPH in COVID-19 patients. The use of anticoagulants may increase the risk of lethal IPH among COVID-19 patients becsuse of scarce data on optimal dosage and adequate monitoring of anticoagulant effects. Rapid diagnosis and timely intervention are crucial to ensure good patient outcomes.

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“…5, performed according to PRISMA criteria, 21 17 studies were included in qualitative and quantitative syntheses. 16,[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] The systematic review identified 40 patients with COVID-19 complicated by muscular hematomas.…”

Section: Systematic Reviewmentioning

confidence: 99%

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

Abate

Casoria

Rendina

et al. 2021

Semin Thromb Hemost

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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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Giant Retroperitoneal Hematoma During Extracorporeal Membrane Oxygenation in a Patient With Coronavirus Disease-2019 Pneumonia

Cited by 15 publications

References 7 publications

Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients

Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients

Case Report: Iliopsoas Hematoma during the Clinical Course of Severe COVID-19 in Two Male Patients

Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series

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