Life‐threatening extrapleural hematoma in an anticoagulated patient 2 weeks after lobectomy

Shimomura, Manabu; Iwasaki, Masashi; Shimegi, Reona; Inoue, Masayoshi

doi:10.1111/1759-7714.14160

Thoracic Cancer

2021

DOI: 10.1111/1759-7714.14160

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Life‐threatening extrapleural hematoma in an anticoagulated patient 2 weeks after lobectomy

Manabu Shimomura

Masashi Iwasaki

Reona Shimegi

et al.

Abstract: We report a case of an anticoagulated patient with sudden onset pleural hematoma after straining at defecation to cardiac arrest on 2 weeks after lobectomy for lung cancer. We decided to perform an emergent operation for an evacuation of extrapleural hematoma immediately after resuscitation. The bleeding point was revealed on the extrapleural thoracic apex. We should be aware that extrapleural hematoma can occur because of increased intrathoracic pressure such as straining during defecation in patients on anti… Show more

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2021

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Apixaban/heparin

2021

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Apixaban/heparin Progression of extrapleural haematoma and haemoptysis: case reportAn 86-year-old man developed progression of extrapleural haematoma (EP) and haemoptysis during anticoagulant treatment with apixaban and heparin [not all routes stated; dosages not stated].The man, who was diagnosed with squamous cell carcinoma of the lung, presented to the hospital for surgical treatment. A chest CT scan showed a 3.4cm cavitary nodule in the right upper lobe as clinical T2aN0M0 stage IB squamous cell carcinoma. He had been receiving anticoagulant treatment with apixaban for brain infarction and atrial fibrillation, since 5 years. His anticoagulant medication was replaced by IV heparin, 7 days before his operation. He underwent thoracoscopic right upper lobectomy and mediastinal lymph node dissection. During the procedure, he had a blood loss of 50g. He progressed well after surgery. On postoperative day (POD) 5, the chest tube was removed. Regarding the anticoagulant treatment, on POD 1, he was restarted on IV heparin. On POD 5, after removal of the chest tube, he switched to apixaban. On POD 11, chest X-ray revealed a small pleural space with effusion on the apex of the thoracic cavity. On POD 15, he suddenly developed a right chest pain and a haemoptysis after straining at defecation. An emergent chest CT scan revealed widespread ground glass opacification in the right lower lobe and huge EP on the right anterior chest wall ranged to thoracic apex. Vital signs examination results were as follows: HR: 140 bpm, BP 85/52 mm Hg, SpO2 92% (nasal O2 2L) and haemoglobin 11.1 g/dL. He abruptly went into cardiac arrest probably due to haemoptysis.The man was resuscitated. Thereafter, he underwent an emergent operation for evacuation of EP. The haematoma was evacuated through 15cm incisions on the fourth and seventh intercostal space. The extrapleural space was occupied with a large amount of haematoma from thoracic apex to lower lateral thoracic wall. After the removal of the haematoma, the bleeding point was found to be on the extrapleural thoracic apex and haemostasis was achieved by a suture. The volume of bleeding was 840g, which confirmed haemorrhagic shock. Under an overnight ventilator control, the haemoptysis stopped and the following day, endobronchial tube was removed. After 10 days of surgery, extrapleural chest tubes were removed. There was no evidence of EP for 6 months. Progression of EP and haemoptysis was attributed to anticoagulant treatment [durations of treatments to reactions onsets not stated].

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Apixaban/heparin

2021

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Life‐threatening extrapleural hematoma in an anticoagulated patient 2 weeks after lobectomy

Cited by 1 publication

References 8 publications

Apixaban/heparin

Apixaban/heparin

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