Novosti
Khirurgii

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Year 2023 Vol. 31 No 2

SCIENTIFIC PUBLICATIONS

T.I. KALENCHIC 1, S.L. KABAK 2, L.G. CEDRIC 2

SPONTANEOUS SOFT TISSUE HEMATOMA IN PATIENTS WITH COVID-19 INFECTION

Belarusian State Medical University 1,
6th City Clinical Hospital 2, Minsk,
Republic of Belarus

Objectives. The aim of this study is to determine the localization of spontaneous subcutaneous and muscle hematomas in patients with the SARS-CoV-2 infection, as well as to analyze changes in the main indicators of blood coagulation.
Material and Methods. The clinical data and the results of laboratory and instrumental studies of 12 patients (five men and seven women, aged 57 to 99 years) with coronavirus infection COVID-19 and spontaneous soft tissue hematomas, who were hospitalized in the therapeutic departments of the 6th Minsk’s city clinical hospital in 2021 - 2022, were analyzed. On the day of admission all patients were prescribed anticoagulants.
Results. Ultrasound and CT revealed 17 hematomas, which were localized in the retroperitoneal space, muscles of the anterior and lateral walls of the abdomen, as well as in the muscles of the thigh and gluteal region. Most often, hemorrhages were found in the soft tissues of the thigh. The volume of fluid in hematomas ranged from 25 to 1200 ml. In five cases, two isolated areas of hemorrhage were identified. In the projection of hematomas subcutaneous hemorrhages were detected. As the hematoma formed, in most cases there was a significant decrease in the level of hemoglobin, which was accompanied by tachycardia and a drop in blood pressure. Hemorrhagic shock of varying severity was diagnosed in all patients using the Algover index. All patients had comorbidities. All of them had a high risk of bleeding according to the HAS-BLED scale (from 3 to 5 points). After discontinuing anticoagulation, hemostatic therapy was prescribed. In 6 cases puncture drainage of the hematoma was performed. Four patients were transfused with red blood cells and fresh frozen plasma. Nine patients after 12-21 days of hospitalization in a satisfactory condition were discharged for outpatient aftercare, one was transferred to the Department of Purulent Surgery. In two cases, death from coronavirus infection and comorbid pathology was ascertained.
Conclusion. Elderly patients with severe and moderate SARS-CoV-2 viral pneumonia may develop spontaneous soft tissue hematomas, including multiple and large ones. Spontaneous hematomas of soft tissues in combination with advanced age, the presence of several concomitant illnesses are a risk factor for death.

Keywords: hematoma, COVID-19 infection, computed tomography, ultrasound, anticoagulants, comorbidity
p. 117-126 of the original issue
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Address for correspondence:
220116, Republic of Belarus,
Minsk, Dzerzhinsky Avenue, 83,
Belarusian State Medical University,
Department of Human Morphology,
tel. +375 (29) 6588339,
e-mail: kabakmorph@gmail.com.
Kabak Sergey Lvovich
Information about the authors:
Kalenchits Tamara Ivanovna, PhD, Associate Professor of the Department of Medical Rehabilitation and Physiotherapy, Belarusian State Medical University; Minsk, Republic of Belarus.
http://org/0000-0003-0387-4937
Kabak Sergey Lvovich, MD, Professor, Head of the Department of Human Morphology, Belarusian State Medical University, Minsk, Republic of Belarus,
http://org/0000-0002-7173-1818
Tsedrik Lyudmila G., Physician, Department of Functional Diagnostics, 6th City Clinical Hospital, Minsk, Republic of Belarus.
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