Mikubo Masashi, Sonoda Dai, Yamazaki Hirotsugu, Naito Masahito, Matsui Yoshio, Shiomi Kazu, Satoh Yukitoshi
Department of Thoracic Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
Int J Surg Case Rep. 2017;39:221-224. doi: 10.1016/j.ijscr.2017.08.040. Epub 2017 Aug 23.
Mediastinal hematoma is usually caused by thoracic trauma or a ruptured aortic aneurysm. Spontaneous non-traumatic mediastinal hematomas are rare but potentially life-threatening conditions that can occur in patients taking anticoagulants.
We report a case of 72-year-old man with a massive mediastinal hematoma associated with anticoagulant therapy. He had complained of acute chest discomfort and subsequent tarry diarrhea. Because he had been taking warfarin for paroxysmal atrial fibrillation, an upper gastrointestinal hemorrhage was initially suspected, but no bleeding was detected by upper endoscopy. A computed tomography scan revealed a massive posterior mediastinal hematoma and markedly compressed surrounding structures. The compression of the left atrium caused a congested lung and exacerbated respiratory and hemodynamic status despite conservative therapy. Therefore, we surgically removed the hematoma. Immediately after removal, the respiratory and hemodynamic conditions improved, and the postoperative course was uneventful.
Spontaneous mediastinal hematoma is rare but can occur in patients who are administered anticoagulants regardless of the therapeutic level of anticoagulation. Although conservative therapy is commonly effective, active surgical intervention should be considered for cases in which the hematoma is symptomatic or conservative therapy is ineffective.
To facilitate prompt and proper management, clinicians should be aware of this condition as a potential complication of anticoagulant therapy.
纵隔血肿通常由胸部创伤或主动脉瘤破裂引起。自发性非创伤性纵隔血肿罕见，但可能危及生命，可发生于服用抗凝剂的患者。
我们报告一例72岁男性患者，患有与抗凝治疗相关的巨大纵隔血肿。他曾主诉急性胸部不适及随后的柏油样腹泻。由于他一直在服用华法林治疗阵发性心房颤动，最初怀疑是上消化道出血，但上消化道内镜检查未发现出血。计算机断层扫描显示巨大的后纵隔血肿，周围结构明显受压。尽管采取了保守治疗，但左心房受压导致肺部充血，呼吸和血流动力学状态恶化。因此，我们通过手术清除了血肿。清除血肿后，呼吸和血流动力学状况立即改善，术后过程顺利。
自发性纵隔血肿罕见，但无论抗凝治疗水平如何，接受抗凝剂治疗的患者都可能发生。虽然保守治疗通常有效，但对于血肿有症状或保守治疗无效的病例，应考虑积极的手术干预。
为便于及时、正确的管理，临床医生应意识到这种情况是抗凝治疗的潜在并发症。
