Recurrent Massive Hemothorax of Unknown Etiology in an 85-Year-Old Man

• Published in: Chest Vol. 161; no. 2; pp. e103 - e110
• Main Authors: Okamatsu, Yuki, Tsubouchi, Kazuya, Iwasaki, Takeshi, Nakamura, Tomoya, Nakashima, Tadayuki, Nakatsuru, Kousei, Takahata, Yuriko, Harada, Taishi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022
• Subjects: Aged, 80 and over; Autopsy; Biopsy; Diagnosis, Differential; Fatal Outcome; Hemangiosarcoma - complications; Hemangiosarcoma - diagnostic imaging; Hemothorax - diagnostic imaging; Hemothorax - etiology; Hemothorax - surgery; Humans; Magnetic Resonance Imaging; Male; Radiography, Thoracic; Recurrence; Thoracoscopy; Tomography, X-Ray Computed; Urinary Bladder Neoplasms - complications; Urinary Bladder Neoplasms - diagnostic imaging
• ISSN: 0012-3692; 1931-3543
• DOI: 10.1016/j.chest.2021.09.012

An 85-year-old Japanese man, who was taking aspirin and edoxaban for previous myocardial infarction and atrial fibrillation, came to our hospital with a chief complaint of dyspnea for 3 weeks. Chest radiography showed a massive left pleural effusion (Fig 1A). Analysis of pleural fluid showed an elevated hematocrit level at 32.8% (blood hematocrit level, 32.0%), and he was diagnosed with hemothorax. However, he had neither coagulation disorder nor thrombocytopenia, and the pleural effusion was negative for atypical cells. These findings suggested that the antithrombotic and anticoagulant medications might have induced the hemothorax.