Hikaru Nakayama1, Asuka Uebayashi2, Shota Yagi3, Shuhei Iizuka2, Yoshiro Otsuki4, Toru Nakamura2. 1. Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan. nakayama.hikaru.301@gmail.com. 2. Department of General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan. 3. Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan. 4. Department of Pathology, Seirei Hamamatsu General Hospital, 2-12-12, Sumiyoshi, Nakaku, Hamamatsu, Shizuoka, 430-8558, Japan.
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.
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.
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Authors: Stefano Aliberti; Pieter C Goeminne; Anne E O'Donnell; Timothy R Aksamit; Hamdan Al-Jahdali; Alan F Barker; Francesco Blasi; Wim G Boersma; Megan L Crichton; Anthony De Soyza; Katerina E Dimakou; Stuart J Elborn; Charles Feldman; Harm Tiddens; Charles S Haworth; Adam T Hill; Michael R Loebinger; Miguel Angel Martinez-Garcia; Jennifer J Meerburg; Rosario Menendez; Lucy C Morgan; Marlene S Murris; Eva Polverino; Felix C Ringshausen; Michal Shteinberg; Nicola Sverzellati; Gregory Tino; Antoni Torres; Thomas Vandendriessche; Montserrat Vendrell; Tobias Welte; Robert Wilson; Conroy A Wong; James D Chalmers Journal: Lancet Respir Med Date: 2021-09-24 Impact factor: 30.700