Nontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung mass
Abstract Background Although bleeding events are the major concern when using oral anticoagulants, intrathoracic hemorrhages due to warfarin are rare. Most cases in the literature have been related to trauma and have manifested as a hemothorax. Here we report a case of a nontraumatic hemorrhage with...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2020-04-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00830-z |
| _version_ | 1819162192121954304 |
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| author | Hiroyuki Tsuchida Ryo Fujikawa Hidenori Nakamura Toru Nakamura |
| author_facet | Hiroyuki Tsuchida Ryo Fujikawa Hidenori Nakamura Toru Nakamura |
| author_sort | Hiroyuki Tsuchida |
| collection | DOAJ |
| description | Abstract Background Although bleeding events are the major concern when using oral anticoagulants, intrathoracic hemorrhages due to warfarin are rare. Most cases in the literature have been related to trauma and have manifested as a hemothorax. Here we report a case of a nontraumatic hemorrhage within a pre-existing pulmonary cyst that presented as a lung mass during warfarin therapy. Case presentation A 75-year-old asymptomatic woman presented with a 10-cm-diameter mass on chest radiography that was not evident 6 months prior. She had been taking warfarin for paroxysmal atrial fibrillation and a transient ischemic attack. There was no history of chest trauma, warfarin overdosing, or any suspected interactions with other drugs such as nonsteroidal anti-inflammatory drugs or antibiotics. The prothrombin time/international normalized ratio(PT-INR) was prolonged at 4.73 and her hemoglobin level was 8.7 g/dl. Chest computed tomography(CT)revealed an air-fluid mass adjacent to the right upper and middle lobes with a pleural effusion. A CT scan obtained 15 years prior revealed a cyst at the corresponding site and the mass was diagnosed as a warfarin-related hemorrhage within the pre-existing pulmonary cyst. We performed a surgical resection of the cyst to prevent any worsening hemorrhage and subsequent infection. The postoperative course was uneventful and the patient was discharged on the 3rd postoperative day. Conclusion A warfarin-related thoracic hemorrhage, other than a hemothorax, could manifest as a pulmonary mass on radiography in patients with pre-existing pulmonary cysts. History taking especially of any anticoagulant medications and a precise assessment of the past images are crucial for a correct diagnosis. Once the intrapulmonary cystic hemorrhage becomes evident, prompt withdrawal with a reversal of warfarin and surgical resection are required to prevent a worsening hemorrhage and subsequent infection. |
| first_indexed | 2024-12-22T17:24:19Z |
| format | Article |
| id | doaj.art-7599b0377899413e93aa3d1a97872942 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-22T17:24:19Z |
| publishDate | 2020-04-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-7599b0377899413e93aa3d1a978729422022-12-21T18:18:46ZengSpringerOpenSurgical Case Reports2198-77932020-04-01611410.1186/s40792-020-00830-zNontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung massHiroyuki Tsuchida0Ryo Fujikawa1Hidenori Nakamura2Toru Nakamura3Department 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 HospitalAbstract Background Although bleeding events are the major concern when using oral anticoagulants, intrathoracic hemorrhages due to warfarin are rare. Most cases in the literature have been related to trauma and have manifested as a hemothorax. Here we report a case of a nontraumatic hemorrhage within a pre-existing pulmonary cyst that presented as a lung mass during warfarin therapy. Case presentation A 75-year-old asymptomatic woman presented with a 10-cm-diameter mass on chest radiography that was not evident 6 months prior. She had been taking warfarin for paroxysmal atrial fibrillation and a transient ischemic attack. There was no history of chest trauma, warfarin overdosing, or any suspected interactions with other drugs such as nonsteroidal anti-inflammatory drugs or antibiotics. The prothrombin time/international normalized ratio(PT-INR) was prolonged at 4.73 and her hemoglobin level was 8.7 g/dl. Chest computed tomography(CT)revealed an air-fluid mass adjacent to the right upper and middle lobes with a pleural effusion. A CT scan obtained 15 years prior revealed a cyst at the corresponding site and the mass was diagnosed as a warfarin-related hemorrhage within the pre-existing pulmonary cyst. We performed a surgical resection of the cyst to prevent any worsening hemorrhage and subsequent infection. The postoperative course was uneventful and the patient was discharged on the 3rd postoperative day. Conclusion A warfarin-related thoracic hemorrhage, other than a hemothorax, could manifest as a pulmonary mass on radiography in patients with pre-existing pulmonary cysts. History taking especially of any anticoagulant medications and a precise assessment of the past images are crucial for a correct diagnosis. Once the intrapulmonary cystic hemorrhage becomes evident, prompt withdrawal with a reversal of warfarin and surgical resection are required to prevent a worsening hemorrhage and subsequent infection.http://link.springer.com/article/10.1186/s40792-020-00830-zWarfarinIntrapulmonary hemorrhageAnticoagulationBleeding events |
| spellingShingle | Hiroyuki Tsuchida Ryo Fujikawa Hidenori Nakamura Toru Nakamura Nontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung mass Surgical Case Reports Warfarin Intrapulmonary hemorrhage Anticoagulation Bleeding events |
| title | Nontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung mass |
| title_full | Nontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung mass |
| title_fullStr | Nontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung mass |
| title_full_unstemmed | Nontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung mass |
| title_short | Nontraumatic warfarin-related intrapulmonary hemorrhage presenting as a lung mass |
| title_sort | nontraumatic warfarin related intrapulmonary hemorrhage presenting as a lung mass |
| topic | Warfarin Intrapulmonary hemorrhage Anticoagulation Bleeding events |
| url | http://link.springer.com/article/10.1186/s40792-020-00830-z |
| work_keys_str_mv | AT hiroyukitsuchida nontraumaticwarfarinrelatedintrapulmonaryhemorrhagepresentingasalungmass AT ryofujikawa nontraumaticwarfarinrelatedintrapulmonaryhemorrhagepresentingasalungmass AT hidenorinakamura nontraumaticwarfarinrelatedintrapulmonaryhemorrhagepresentingasalungmass AT torunakamura nontraumaticwarfarinrelatedintrapulmonaryhemorrhagepresentingasalungmass |