Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant
Abstract Background A hemothorax as the initial manifestation of bronchiectasis is extremely rare. We report a case of a sudden hemothorax due to exacerbation of clinically latent bronchiectasis under a direct oral anticoagulant. Case presentation A 77-year-old woman presented with chest pain and a...
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| Language: | English |
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Japan Surgical Society
2022-09-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-022-01536-0 |
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| author | Hikaru Nakayama Asuka Uebayashi Shota Yagi Shuhei Iizuka Yoshiro Otsuki Toru Nakamura |
| author_facet | Hikaru Nakayama Asuka Uebayashi Shota Yagi Shuhei Iizuka Yoshiro Otsuki Toru Nakamura |
| author_sort | Hikaru Nakayama |
| collection | DOAJ |
| description | Abstract Background A hemothorax as the initial manifestation of bronchiectasis is extremely rare. We report a case of a sudden hemothorax due to exacerbation of clinically latent bronchiectasis under a direct oral anticoagulant. Case presentation A 77-year-old woman presented with chest pain and a fever noted since the day before. She had stage G3 chronic kidney disease and received edoxaban for paroxysmal atrial fibrillation. She had no history of trauma or respiratory symptoms. A chest computed tomography revealed a mass with a surrounding opacity in the right lower lobe with a pleural effusion. Conservative treatment was chosen because of the stable vital signs and her respiratory condition. Her oxygen saturation dropped 7 h later with progressive anemia. Repeated chest computed tomography showed a worsening pulmonary opacity and pleural effusion. She underwent a right lower lobectomy successfully. The histopathological findings suggested that the preceding infection of the subpleural focal bronchiectasis caused the bleeding. In addition, a steep caliber change between the subpleural focal bronchiectasis and proximal normal branch may have caused an intraluminal pressure gradient resulting in a peripheral discharge causing a pleural rupture with a hemothorax. Conclusion The sudden hemothorax could have been the initial manifestation of bronchiectasis. Particular attention should be paid to peripherally localized bronchiectasis even if it is without any clinical symptoms, especially in patients with a comorbidity such as a susceptibility to infections and the use of direct oral anticoagulants. |
| format | Article |
| id | doaj-art-e4e2195e8a934e2c8cb44c8d2203222a |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2022-09-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-e4e2195e8a934e2c8cb44c8d2203222a2025-08-20T03:57:59ZengJapan Surgical SocietySurgical Case Reports2198-77932022-09-01811410.1186/s40792-022-01536-0Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulantHikaru Nakayama0Asuka Uebayashi1Shota Yagi2Shuhei Iizuka3Yoshiro Otsuki4Toru Nakamura5Department of General Thoracic Surgery, Seirei Hamamatsu General HospitalDepartment of General Thoracic Surgery, Seirei Hamamatsu General HospitalDepartment of Respiratory Medicine, Seirei Hamamatsu General HospitalDepartment of General Thoracic Surgery, Seirei Hamamatsu General HospitalDepartment of Pathology, Seirei Hamamatsu General HospitalDepartment of General Thoracic Surgery, Seirei Hamamatsu General HospitalAbstract Background A hemothorax as the initial manifestation of bronchiectasis is extremely rare. We report a case of a sudden hemothorax due to exacerbation of clinically latent bronchiectasis under a direct oral anticoagulant. Case presentation A 77-year-old woman presented with chest pain and a fever noted since the day before. She had stage G3 chronic kidney disease and received edoxaban for paroxysmal atrial fibrillation. She had no history of trauma or respiratory symptoms. A chest computed tomography revealed a mass with a surrounding opacity in the right lower lobe with a pleural effusion. Conservative treatment was chosen because of the stable vital signs and her respiratory condition. Her oxygen saturation dropped 7 h later with progressive anemia. Repeated chest computed tomography showed a worsening pulmonary opacity and pleural effusion. She underwent a right lower lobectomy successfully. The histopathological findings suggested that the preceding infection of the subpleural focal bronchiectasis caused the bleeding. In addition, a steep caliber change between the subpleural focal bronchiectasis and proximal normal branch may have caused an intraluminal pressure gradient resulting in a peripheral discharge causing a pleural rupture with a hemothorax. Conclusion The sudden hemothorax could have been the initial manifestation of bronchiectasis. Particular attention should be paid to peripherally localized bronchiectasis even if it is without any clinical symptoms, especially in patients with a comorbidity such as a susceptibility to infections and the use of direct oral anticoagulants.https://doi.org/10.1186/s40792-022-01536-0BronchiectasisHemothoraxDirect oral anticoagulant |
| spellingShingle | Hikaru Nakayama Asuka Uebayashi Shota Yagi Shuhei Iizuka Yoshiro Otsuki Toru Nakamura Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant Surgical Case Reports Bronchiectasis Hemothorax Direct oral anticoagulant |
| title | Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant |
| title_full | Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant |
| title_fullStr | Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant |
| title_full_unstemmed | Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant |
| title_short | Sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant |
| title_sort | sudden hemothorax as a rare initial manifestation of bronchiectasis under a direct oral anticoagulant |
| topic | Bronchiectasis Hemothorax Direct oral anticoagulant |
| url | https://doi.org/10.1186/s40792-022-01536-0 |
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