Spontaneous mediastinal haematoma: a rare complication of warfarin therapy

Abstract

SummaryA 64-year-old woman presented with shortness of breath, right-sided pleuritic chest pain and dry cough. She was systemically anticoagulated with warfarin for a pulmonary embolism diagnosed 3 months previously, with an international normalised ratio (INR) of 3.0 on presentation. Chest radiograph demonstrated a new right paratracheal abnormality, and CT scan showed a large mediastinal mass not present 3 weeks earlier. MRI demonstrated an ovoid mass with a fl uid/fl uid level with high T2 and dark T1 signal consistent with a mediastinal haematoma. The patient's anticoagulation was emergently reversed and a temporary inferior vena cava fi lter was placed. The haematoma slowly resolved on serial follow-up with no additional intervention. Spontaneous mediastinal haematoma is a rare but life-threatening diagnosis that frequently presents with chest pain, dry cough and dysphagia. It is frequently associated with therapeutic anticoagulation and may potentially be caused by sudden, atraumatic rise in intrathoracic pressure (ie, cough or emesis).

Mediastinal hematoma after trans-radial cerebral angiography: a case report

“…Antiplatelet agents are widely known for their role in inhibiting platelet aggregation, which increases the risk of bleeding. Additionally, spontaneous mediastinal hematomas have been reported in patients undergoing anticoagulant therapy [ 17 , 18 ]. Based on the pharmacological effects of these drugs, it is plausible that administering antiplatelet treatment may increase a patient’s vulnerability to hematoma formation after DSA.…”

Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review

“…Although anticoagulant therapy is widely used in the management of various cardiovascular diseases, and hemorrhage is a commonly recognized complication, most hemorrhages occur in the mucosal region, such as the gastrointestinal tract, urinary tract or gynecological organs [5] . Only nine cases of mediastinal hematomas associated with anticoagulant therapy have been reported in the literature ( Table 1 ) [1] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] . The anticoagulant treatments involved a variety of drugs, including warfarin, heparin, thrombolytic agents, and aspirin.…”

Posterior mediastinal mass compressing the left atrium: A rare complication after lung resection

“…The most frequent reported haematoma are those related to the thoracic trauma [5]. However, spontaneous haematomas are rare but can occur due to anticoagulation usage [6,7] or related to bleeding from mediastainal…”