Hemorrhagic shock due to spontaneous pectoral hematoma associated with anticoagulation therapy

摘要

A 78-year-old male with a history of paroxysmal atrial fibrillation, coronary artery disease, hypertension, and chronic kidney disease, on warfarin and aspirin, presented after a syncopal episode. While sitting, he suddenly felt lightheaded and passed out. Exam was notable for a blood pressure of 70/40 mmHg, heart rate of 110 beats/min, and a large ecchymosis across his anterior chest (Fig. 1). There was no history of fall or trauma. Labs revealed a hemoglobin level of 4.2 g/dL and INR 7.8. Computed tomography (CT) of the chest demonstrated bilateral pectoral hematomas (Fig. 2). The patient's hemodynamic status improved with fluids, blood transfusions and reversal of anticoagulation. Warfarin was discontinued on discharge. Most cases of muscular hematomas have been described in context of invasive procedures or trauma.