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

INTRODUCTION: Mediastinal hematoma is usually caused by thoracic trauma or a ruptured aortic aneurysm. Spontaneous non-traumatic mediastinal hematomas are rare but potentially life-threatening conditions that can occur in patients taking anticoagulants. PRESENTATION OF CASE: We report a case of 72-y...

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Autores principales: Mikubo, Masashi, Sonoda, Dai, Yamazaki, Hirotsugu, Naito, Masahito, Matsui, Yoshio, Shiomi, Kazu, Satoh, Yukitoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581373/
https://www.ncbi.nlm.nih.gov/pubmed/28858739
http://dx.doi.org/10.1016/j.ijscr.2017.08.040
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author Mikubo, Masashi
Sonoda, Dai
Yamazaki, Hirotsugu
Naito, Masahito
Matsui, Yoshio
Shiomi, Kazu
Satoh, Yukitoshi
author_facet Mikubo, Masashi
Sonoda, Dai
Yamazaki, Hirotsugu
Naito, Masahito
Matsui, Yoshio
Shiomi, Kazu
Satoh, Yukitoshi
author_sort Mikubo, Masashi
collection PubMed
description INTRODUCTION: Mediastinal hematoma is usually caused by thoracic trauma or a ruptured aortic aneurysm. Spontaneous non-traumatic mediastinal hematomas are rare but potentially life-threatening conditions that can occur in patients taking anticoagulants. PRESENTATION OF CASE: We report a case of 72-year-old man with a massive mediastinal hematoma associated with anticoagulant therapy. He had complained of acute chest discomfort and subsequent tarry diarrhea. Because he had been taking warfarin for paroxysmal atrial fibrillation, an upper gastrointestinal hemorrhage was initially suspected, but no bleeding was detected by upper endoscopy. A computed tomography scan revealed a massive posterior mediastinal hematoma and markedly compressed surrounding structures. The compression of the left atrium caused a congested lung and exacerbated respiratory and hemodynamic status despite conservative therapy. Therefore, we surgically removed the hematoma. Immediately after removal, the respiratory and hemodynamic conditions improved, and the postoperative course was uneventful. DISCUSSION: Spontaneous mediastinal hematoma is rare but can occur in patients who are administered anticoagulants regardless of the therapeutic level of anticoagulation. Although conservative therapy is commonly effective, active surgical intervention should be considered for cases in which the hematoma is symptomatic or conservative therapy is ineffective. CONCLUSION: To facilitate prompt and proper management, clinicians should be aware of this condition as a potential complication of anticoagulant therapy.
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spelling pubmed-55813732017-09-06 Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review Mikubo, Masashi Sonoda, Dai Yamazaki, Hirotsugu Naito, Masahito Matsui, Yoshio Shiomi, Kazu Satoh, Yukitoshi Int J Surg Case Rep Article INTRODUCTION: Mediastinal hematoma is usually caused by thoracic trauma or a ruptured aortic aneurysm. Spontaneous non-traumatic mediastinal hematomas are rare but potentially life-threatening conditions that can occur in patients taking anticoagulants. PRESENTATION OF CASE: We report a case of 72-year-old man with a massive mediastinal hematoma associated with anticoagulant therapy. He had complained of acute chest discomfort and subsequent tarry diarrhea. Because he had been taking warfarin for paroxysmal atrial fibrillation, an upper gastrointestinal hemorrhage was initially suspected, but no bleeding was detected by upper endoscopy. A computed tomography scan revealed a massive posterior mediastinal hematoma and markedly compressed surrounding structures. The compression of the left atrium caused a congested lung and exacerbated respiratory and hemodynamic status despite conservative therapy. Therefore, we surgically removed the hematoma. Immediately after removal, the respiratory and hemodynamic conditions improved, and the postoperative course was uneventful. DISCUSSION: Spontaneous mediastinal hematoma is rare but can occur in patients who are administered anticoagulants regardless of the therapeutic level of anticoagulation. Although conservative therapy is commonly effective, active surgical intervention should be considered for cases in which the hematoma is symptomatic or conservative therapy is ineffective. CONCLUSION: To facilitate prompt and proper management, clinicians should be aware of this condition as a potential complication of anticoagulant therapy. Elsevier 2017-08-23 /pmc/articles/PMC5581373/ /pubmed/28858739 http://dx.doi.org/10.1016/j.ijscr.2017.08.040 Text en © 2017 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Mikubo, Masashi
Sonoda, Dai
Yamazaki, Hirotsugu
Naito, Masahito
Matsui, Yoshio
Shiomi, Kazu
Satoh, Yukitoshi
Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review
title Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review
title_full Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review
title_fullStr Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review
title_full_unstemmed Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review
title_short Spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: A case report and literature review
title_sort spontaneous non-traumatic mediastinal hematoma associated with oral anticoagulant therapy: a case report and literature review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581373/
https://www.ncbi.nlm.nih.gov/pubmed/28858739
http://dx.doi.org/10.1016/j.ijscr.2017.08.040
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