Case Reports
Vol. 17 No. 1 (2023)
Hemorrhagic complications in COVID-19: three women with pectoral hematoma and a review
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 4 July 2023
1263
Views
407
Downloads
27
HTML
Authors
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.
Downloads
Download data is not yet available.
Citations
Marietta M, Ageno W, Artoni A, et al. COVID-19 and haemostasis: a position paper from Italian Society on Thrombosis and Haemostasis (SISET). Blood Transfus 2020;18:167-9.
Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res 2020;191:9-14.
Al-Samkari H, Karp Leaf RS, Dzik WH, et al. COVID-19 and coagulation: bleeding and thrombotic manifestations of SARS-CoV-2 infection. Blood 2020;136:489-500.
McFadyen JD, Stevens H, Peter K. The emerging threat of (micro)thrombosis in COVID-19 and its therapeutic implications. Review. Circ Res 2020;127:571-87.
Miesbach W, Makris M. COVID-19: coagulopathy, risk of thrombosis, and the rationale for anticoagulation. Clin and Appl Thromb Hemost 2020;26:1-7.
Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;135:2033-40.
Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2.
Duca A, Memaj I, Zanardi F, et al. Severity of respiratory failure and outcome of patients needing a ventilator support in the Emergency Department during Italian novel coronavirus SARS-CoV2 outbreak: preliminary data on the role of helmet CPAP and non-invasive positive pressure ventilation. EClinicalMedicine 2020;24:100419.
Gattinoni L, Busana M, Giosa L, et al. Prone positioning in acute respiratory distress syndrome. Semin Respir Crit Care Med 2019;40:94-100.
Longhini F, Bruni A, Garofalo E, et al. Helmet continuous positive airway pressure and prone positioning: a proposal for an early management of COVID-19 patients. Pulmonology 2020;26:186-91.
Bastoni D, Poggiali E, Vercelli A, et al. Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department. Emerg Med J 2020;37:565-6.
Guérin C, Reignier J, Richard JC, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med 2013; 368:2159-68.
Scaravilli V, Grasselli G, Castagna L, et al. Prone positioning improves oxygenation in spontaneously breathing non-intubated patients with hypoxemic acute respiratory failure: a retrospective study. J Crit Care 2015;30:1390-4.
SIMIT (Società Italiana di Malattie Infettive e Tropicali). Vademecum per la cura delle persone con malattia da COVID-19, ed 2.0. 13th March 2020. Available from: http://www.simit.org/simit/sezioni-regionali/lombardia/comunicazioni/214-vademecum-COVID-19.
Benazzi D, Antonicelli V, Presciuttini B, et al. COVID-19 and hemorrhagic complications: pectoral hematoma. Ital J Emerg Med 2021;10:6-10.
The ARDS Definition Task Force (2012). Acute Respiratory distress syndrome: the Berlin definition. JAMA 2012;307: 2526-33.
Koklu H, Koklu NO, Khurami FA, et al. Therapy-related spontaneous pectoral muscle hematoma: a case report and review of the literature. J Am Geriatr Soc 2016;64:1135-7.
Yang JC, Makaryus AN. Warfarin anticoagulation and spontaneous pectoral haematoma. Heart Lung Circ 2016;25:e81-4.
Bargellini I, Cervelli R, Lunardi A, et al. Spontaneous bleedings in COVID-19 patients: an emerging complication. Cardiovasc Intervent Radiol 2020;43:1095-6.
Abate V, Casoria A, Rendina D, et al. Spontaneous muscle hemathoma in patients with COVID-19: a systematic literature review with description of an additional case series. Semin Thromb Hemost 2022; 48:100-8.
Taleja H, Nair VV, Yadav S, et al. Spontaneous hematomas in COVID-19 patients on low-molecular-weight heparin. Dubai Med J 2021;4:285-90.
Okuturlar Y, Gurleyik D, Ramoglu N, et al. Pectoral muscle hematoma as a complication of COVID-19 treatment: a case report. Turk J Int Med 2021;3:S79-S81.
Lopez-Martinez L, Molina-Nuevo JD, Pedrosa-Jimenez MJ, Julia-Molla E. Spontaneous haematomas in anticoagulated COVID-19 patients: diagnosis and treatment by embolization. Cardiovasc Intervent Radiol 2022;45:1001-6.
Singh B, Mechineni A, Kaur, et al. COVID-19 and bleeding at unusual locations: report of four cases. Hematol Transfus Cell Ther 2021;43:214-218.
Sottilotta G, Mangano C, Basile R, et al. Iliopsoas hematoma in patients with COVID-19 on low-molecular-weight heparin treatment. SAGE Open Med Case Rep 2021;9:1-4.
Scarduelli C, Inglese F, Beccaria M, et al. Pulmonary embolism in patients with severe COVID-19 treated with intermediate-to full-dose enoxaparin: a retrospective study. Monaldi Arch Chest Dis 2021;91:1758.
Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and Thromboembolic Disease: Implications for Prevention Antithrombotic Therapy and Follow-up. J Am Coll Cardiol 2020; 75:2950-73.
How to Cite
Hemorrhagic complications in COVID-19: three women with pectoral hematoma and a review. (2023). Italian Journal of Medicine, 17(1). https://doi.org/10.4081/itjm.2023.1590
Copyright (c) 2023 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.