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Abdurabu M, Al-Warqi A, Ebrahim EM, Mirza S, Kolleri J. Renal Angiomyolipoma Rupture Following COVID-19 Infection: A Case Report. Cureus 2023; 15:e41734. [PMID: 37575702 PMCID: PMC10415169 DOI: 10.7759/cureus.41734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
The novel Coronavirus (COVID-19) is one of the most recent Pandemics that invaded the earth and is still active. It caused and is still causing hundreds of thousands of patients high morbidity and mortality rates, with no definitive cure at this moment. COVID-19 has been proven to be associated with pathologic changes in coagulation, characterized by either thromboembolic or bleeding events. We describe this case of a 44-year-old male patient who walked into our emergency department with flank pain and was later discovered to have had renal angiomyolipoma (AML) rupture during his COVID-19 infection, ultimately requiring admission for hemorrhage control via interventional radiology (IR) drainage. Here, we discuss the role of front-line physicians and how they should keep a low threshold for the different presentations that could be associated with COVID-19 infection, such as what was found in this case.
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Affiliation(s)
| | | | - Ebrahim M Ebrahim
- Family Medicine, Medical Education, Hamad Medical Corporation, Doha, QAT
| | - Salman Mirza
- Clinical Imaging, Hamad Medical Corporation, Doha, QAT
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2
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Hashemi H, Moradi H, Hashemi M, Naderi Z, Jafarpisheh S. Retroperitoneal hematoma in patients with COVID-19 infection during anticoagulant therapy: A case series and literature review. J Int Med Res 2022; 50:3000605221119662. [PMID: 36076361 PMCID: PMC9465591 DOI: 10.1177/03000605221119662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Due to the hypercoagulable status of patients with severe COVID-19 infection,
anticoagulants are often used to prevent thrombosis. However, these agents may
cause bleeding events such as retroperitoneal hematoma (RPH). We report here on
six patients with COVID-19 who developed RPH during treatment. Early evidence of
bleeding led to confirmatory diagnosis with imaging. Four patients recovered
with supportive treatment (IV fluids and blood transfusions) and two patients
recovered by angioembolization. RPH should be considered in COVID patients on
anticoagulants as soon as haemoglobin or blood pressure falls. Further studies
are required to provide guidance and recommendations on use of anticoagulants in
critically ill patients with COVID-19.
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Affiliation(s)
- Huriyeh Hashemi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Hazhir Moradi
- Isfahan Students Research Committee, Medical School, Isfahan University of Medical Science, Isfahan, Iran
| | - Marzieh Hashemi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Zohre Naderi
- Department of Internal Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Saleh Jafarpisheh
- Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran
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Khalighi E, Marzban-Rad S, Taheri HR. Acute Progressive retro-peritoneal hematoma in COVID19 patients with sub cutaneous ecchymosis. Ann Med Surg (Lond) 2022; 79:104107. [PMID: 35784949 PMCID: PMC9238019 DOI: 10.1016/j.amsu.2022.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/26/2022] [Accepted: 06/26/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction and importance: COVID19 is a multifunction disease where hematological disorders are reported. Coagulopathy is seen in these patients, indicated by thromboembolic events. Case presentation We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body and retroperitoneal hematoma in the posterior wall of the abdomen and chest. Clinical discussion Increased INR and bleeding and ecchymosis in Corona patients require discontinuation of anticoagulants and, FFP, essential and tri amino injections are needed. Conclusions Diagnosis and management of hematoma is important to avoid fatality. Global upsurge in COVID19 cases has been marked with systemic manifestations. We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions. We present COVID19 patients who were treated with anticoagulants and were seen to be presented with retroperitoneal hematoma.
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Affiliation(s)
- Ebrahim Khalighi
- Department of Anesthesiology, School of Allied Medical Sciences, Shahid Mostafa Khomaeini Hospital, Ilam University of Medical sciences, Ilam, Iran
| | - Saeid Marzban-Rad
- Department of Surgery, Imam-Reza Hospital, Aja University of Medical Sciences, Tehran, Iran
- Corresponding author.
| | - Hamid Reza Taheri
- Department of Surgery, School of Medicine, Shahed University, Tehran, Iran
- Corresponding author.
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Marzban-Rad S, Bahmani S, Kazemi A, Taheri HR. Acute retroperitoneal hematoma following severe Covid-19 and the use of anticoagulants. Ann Med Surg (Lond) 2022; 78:103909. [PMID: 35693103 PMCID: PMC9173825 DOI: 10.1016/j.amsu.2022.103909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/27/2022] [Accepted: 06/02/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction and Importance: Severe COVID19 patients under anticoagulant therapy are at the risk of developing hematoma. Case presentation We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body and retroperitoneal hematoma in the posterior wall of the abdomen and chest. Clinical discussion Cases of hematoma with severe COVID19 patients under anticoagulant therapy are reported in several case studies, particularly in geriatric population with the previous history of blood and/or cardiac disorders. Conclusion These patients should be carefully monitored for hematomas by skilled nurse and practitioner and timely treated and monitored. - Global upsurge in COVID19 cases has been marked with systemic manifestations. Clinical studies have indicated thromboembolic events and vascular injuries in COVID19 patients. We present case of 11 COVID19 who were presented with localized skin ecchymosis lesions in different areas of the body. Alterations in biochemical parameters should also be monitored closely.
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Affiliation(s)
- Saeid Marzban-Rad
- Department of Surgery, Imam-Reza Hospital, Aja University of Tehran Medical Sciences, Tehran, Iran
| | - Sahar Bahmani
- Zist Takhmir Pharmaceutical Company, Tehran University of Medical Sciences, Tehran, Iran
| | - Amenehsadat Kazemi
- Department of Psychology, Faculty of Medical, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hamid Reza Taheri
- Department of Surgery, School of Medicine, Shahed University, Tehran, Iran
- Corresponding author.
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Yoshioka T, Daizumoto K, Tada K, Mima M, Kagawa K, Fukawa T, Yamaguchi K, Takahashi M, Nishioka Y, Kanayama H. Retroperitoneal hemorrhage in a patient with coronavirus disease 2019 (COVID-19):A case report. THE JOURNAL OF MEDICAL INVESTIGATION 2022; 69:148-151. [PMID: 35466138 DOI: 10.2152/jmi.69.148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Early prophylactic administration of anticoagulants is recommended in patients with coronavirus disease 2019 (COVID-19). A case of retroperitoneal hemorrhage during inpatient treatment for COVID-19 is reported. CASE PRESENTATION A 69-year-old man was diagnosed with COVID-19 6 days after symptom onset. After admission for difficulty of breathing, he was treated with steroid pulse therapy, remdesivir, and heparin sodium. On day 16 after admission, his hemoglobin and blood pressure dropped. Computed tomography showed a left retroperitoneal hematoma and multiple areas of extravasation in bilateral iliopsoas muscles. Anticoagulation therapy was stopped, and blood transfusion therapy was chosen by considering poor general condition caused by severe pneumonia. On day 19, the hemoglobin and blood pressure improved, and blood transfusion was stopped. However, he died on day 25 due to pneumonia. CONCLUSION When retroperitoneal hemorrhage occurs as a complication of COVID-19, appropriate treatment decision, transcatheter arterial embolization or conservative treatment, should be chosen based on patient's condition. J. Med. Invest. 69 : 148-151, February, 2022.
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Affiliation(s)
- Takuya Yoshioka
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kouki Tada
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masato Mima
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kozo Kagawa
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
| | - Hiroomi Kanayama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Tokushima, Japan
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6
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Alakuş Ü, Kara U, Çimen Ş, Taşçı C, Eryılmaz M. Life-threatening hematomas in COVID-19 patients. ULUS TRAVMA ACIL CER 2022; 28:477-482. [PMID: 35485522 PMCID: PMC10443135 DOI: 10.14744/tjtes.2021.92335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND The COVID-19 pandemic has caused over 1.75 million deaths in the world to date. Although the leading cause of mortality is respiratory disorders and thromboembolic pathologies, other rare pathologies may also increase mortality and morbidity. In our study, we aimed to examine life-threatening hematomas, risk factors, and management during COVID-19. METHODS Institutional center (a third level pandemic center) database was searched for patients hospitalized for COVID-19 during 10 months period between March 11, 2020, and December 17, 2020, retrospectively. Patients with bleeding symptoms/signs were de-tected. Patients with gastrointestinal system bleeding were excluded from the study. Patients with hematomas were included in the study. RESULTS Eleven of a total 5484 patients had hematomas (0.2%). Median age was 76 (min-max: 56-90). Seven (63.6%) patients were male and 4 (36.4%) were female. All patients had at least one comorbidities, been under treatment dose of low-molecular-weight hep-arin (LMWH) and severe or critical COVID-19 disease. Seven retroperitoneal hematomas, two rectus sheath hematomas, one breast hematoma, and in one patient both retroperitoneal and breast hematomas were diagnosed. Angiographic arterial embolization was applied to 5 (45.5%) patients. Overall mortality rate in patients with bleeding complications was 54.5% (n=6), and the male-to-female ratio was 66.7% (n=4) versus 33.3% (n=2). CONCLUSION Hematomas are rare, but mortality increasing phenomena in COVID-19 patients. Age, male gender, severe or critical COVID-19 disease, comorbidities, and treatment dose of LMWH may be risk factors. New onset of abdominal/back pain and ecchymotic skin lesions may be signs of bleeding in this patient group. Mortality can be reduced by early diagnosis of hematoma and interventional methods.
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Affiliation(s)
- Ümit Alakuş
- Department of General Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey
| | - Umut Kara
- Department of Anesthesiology and Reanimation, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey
| | - Şebnem Çimen
- Department of General Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey
| | - Cantürk Taşçı
- Department of Pulmonology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey
| | - Mehmet Eryılmaz
- Department of General Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey
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7
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Life-Threatening Retroperitoneal Hematoma in a Patient with COVID-19. Case Rep Hematol 2021; 2021:8774010. [PMID: 34745669 PMCID: PMC8570906 DOI: 10.1155/2021/8774010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/17/2021] [Accepted: 10/27/2021] [Indexed: 12/13/2022] Open
Abstract
COVID-19 is a respiratory illness that affects the human body in many different ways. The disease carries both thrombotic and hemorrhagic complications, especially in those patients who are anticoagulated to prevent the thromboembolic manifestations. In this report, we discuss a case of retroperitoneal hemorrhage in a patient treated with therapeutic anticoagulation which ultimately led to the patient's death. The literature highlights the importance of anticoagulation because it reduces mortality in patients hospitalized with COVID-19. Although, more recent studies suggest that patients treated with therapeutic anticoagulation are at a higher risk of hemorrhage and increased mortality. Therefore, our case stresses the importance of active monitoring of these patients to detect any suspected case of hemorrhage early to reduce mortality. Overall, more research should be conducted to determine the optimal dosing of anticoagulation that balances safety and efficacy.
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Abate V, Casoria A, Rendina D, Muscariello R, Nuzzo V, Vargas M, Servillo G, Venetucci P, Conca P, Tufano A, Galletti F, Di Minno G. Spontaneous Muscle Hematoma in Patients with COVID-19: A Systematic Literature Review with Description of an Additional Case Series. Semin Thromb Hemost 2021; 48:100-108. [PMID: 34388842 DOI: 10.1055/s-0041-1732370] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
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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Affiliation(s)
- Veronica Abate
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Aniello Casoria
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Domenico Rendina
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | | | - Vincenzo Nuzzo
- Endocrinology and Nutrition Department, Ospedale del Mare, Naples, Italy
| | - Maria Vargas
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Giuseppe Servillo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II," Naples, Italy
| | - Pietro Venetucci
- Department of Morphological and Functional Diagnostics, Radiotherapy, Forensic Medicine, University of Naples "Federico II," Naples, Italy
| | - Paolo Conca
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Ferruccio Galletti
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
| | - Giovanni Di Minno
- Department of Clinical Medicine and Surgery, "Federico II" University Hospital, Naples, Italy
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Vaidya T, Nanivadekar A, Patel R. Imaging spectrum of abdominal manifestations of COVID-19. World J Radiol 2021; 13:157-170. [PMID: 34249237 PMCID: PMC8245751 DOI: 10.4329/wjr.v13.i6.157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/11/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has posed a serious threat to global public health with its rapid spread, high fatality, and severe burden on health care providers all over the world. Although COVID-19 has been established as a respiratory tract infection, it can manifest with gastrointestinal symptoms as a consequence of direct infection by the virus or due to inflammation-mediated cytotoxicity. It has been observed that COVID-19 patients presenting with gastrointestinal symptoms tend to progress to a severe form of disease with increased morbidity and mortality, thus indicating the need for timely management. COVID-19 manifests with a wide spectrum of radiologic findings on gastrointestinal tract imaging, encompassing bowel abnormalities, hepato-biliary and pancreatic involvement, vascular occlusion, and solid organ infarction. Early recognition of these imaging features can facilitate timely treatment of COVID-19 associated gastrointestinal tract complications and may prompt the diagnosis of COVID-19 in patients with atypical disease manifestations. The aim of this article is to provide an overview of the various gastrointestinal imaging manifestations that can be encountered in patients with COVID-19, with an emphasis on early diagnosis of the disease as well as treatment related complications.
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Affiliation(s)
- Tanvi Vaidya
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
| | | | - Rajan Patel
- Department of Radiology, Ruby Hall Clinic, Pune 411001, Maharashtra, India
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Mahboubi-Fooladi Z, Pourkarim Arabi K, Khazaei M, Nekooghadam S, Shadbakht B, Moharamzad Y, Sanei Taheri M. Parenteral Anticoagulation and Retroperitoneal Hemorrhage in COVID-19: Case Report of Five Patients. ACTA ACUST UNITED AC 2021; 3:2005-2010. [PMID: 34222798 PMCID: PMC8233187 DOI: 10.1007/s42399-021-01006-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
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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Affiliation(s)
- Zahra Mahboubi-Fooladi
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kowsar Pourkarim Arabi
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Khazaei
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sayyedmojtaba Nekooghadam
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bita Shadbakht
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yashar Moharamzad
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Morteza Sanei Taheri
- Department of Radiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Iranian Society of Radiology, Tehran, Iran
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11
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Young J, Kalczynski J, Emerling A, Bianchi W. Renal angiomyolipoma rupture in a young female with COVID-19. Am J Emerg Med 2021; 47:316.e1-316.e3. [PMID: 33741199 PMCID: PMC7879133 DOI: 10.1016/j.ajem.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/28/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022] Open
Abstract
While primarily a respiratory illness, infection with the novel coronavirus (COVID-19) is associated with pathologic changes in coagulation, characterized by both thromboembolic and bleeding events. We present the case of a 22-year-old female diagnosed with renal angiomyolipoma (AML) rupture 2 weeks after COVID-19 infection, ultimately requiring admission for hemorrhage control via endovascular embolization. Emergency medicine physicians should maintain a high index of suspicion for renal AML rupture and other spontaneous bleeding events in patients with recent COVID-19 infection due to a possible correlation between the two.
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Affiliation(s)
- Jocelyn Young
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States.
| | - Jeffrey Kalczynski
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
| | - Alec Emerling
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
| | - William Bianchi
- Department of Emergency Medicine, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, United States
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12
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Nakamura H, Ouchi G, Miyagi K, Higure Y, Otsuki M, Nishiyama N, Kinjo T, Nakamatsu M, Tateyama M, Kukita I, Fujita J. Case Report: Iliopsoas Hematoma during the Clinical Course of Severe COVID-19 in Two Male Patients. Am J Trop Med Hyg 2021; 104:1018-1021. [PMID: 33534775 PMCID: PMC7941852 DOI: 10.4269/ajtmh.20-1507] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/29/2020] [Indexed: 12/19/2022] Open
Abstract
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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Affiliation(s)
- Hideta Nakamura
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Gen Ouchi
- 2Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Kazuya Miyagi
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yuuri Higure
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mariko Otsuki
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Naoya Nishiyama
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Takeshi Kinjo
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masashi Nakamatsu
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Masao Tateyama
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Ichiro Kukita
- 2Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Jiro Fujita
- 1Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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