Spontaneous giant chest wall hematomas in COVID-19 patients: case report

Background: Spontaneous chest wall hematomas are an extremely rare clinical finding. Bleeding manifestations without other associated factors have not yet been re-ported in COVID-19 disease. Case Description: We report the cases of two patients with severe COVID-19 disease who debuted with a giant spontaneous chest wall hematoma at our institution without a history of traumatic event or previous invasive procedure. Both patients, a 75-year-old male and a 96-year-old woman, were in a resolution stage of their COVID-19 bilateral pneumonia and were receiving prophylactic dose low-molecular-weight heparin. The initial symptoms in both patients were the appearance of chest pain with a rapidly progressive indurated mass in the pectoral region. The imaging test of choice were computed chest tomography and an angiographic study, which allowed the identification of the possible origin of the bleeding and its subsequent selective embolization. Surgical drainage of the hematoma was necessary in one of the patients. Both patients presented a good clinical evolution, being able to be discharged from the hospital approximately one week after admission, with hematoma in the resolution phase and without clinical, laboratory or radiological data of active bleeding. Conclusions: We consider it necessary to individualize antithrombotic prophylaxis in COVID-19 disease until the risk-benefit ratio is delimited. © 2022 by Prusa Medical Publishing.