CTICasesSpontaneous Muscular Hematoma and Hemothorax secondary to Anticoagulation
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Imaging findings
Initial chest CT, performed for chest pain, shows a muscular hematoma in the left chest wall, presumed to be the source of the patient's left-sided chest pain. Follow-up imaging after re-presentation demonstrates the development of pleural fluid, which was confirmed as a hemothorax requiring a chest tube. No pulmonary embolism was identified on either study.
Key takeaways
Anticoagulation, even at therapeutic levels, carries a risk of significant bleeding complications such as muscular hematomas and hemothorax, which can cause acute chest pain. These can be insidious and progress, requiring repeat imaging and intervention. It's crucial to consider bleeding complications in anticoagulated patients presenting with new or worsening symptoms like chest pain or dyspnea, even if initial imaging for common pathologies (e.g., PE) is negative.
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