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Spontaneous bilateral haemothorax and haemopericardium : case report An 81-year-old woman developed bilateral spontaneous haemothorax and haemopericardium during treatment with rivaroxaban for deep vein thrombosis (DVT) and celecoxib for left knee arthritis [routes not stated]. The woman who had a history of DVT presented to the emergency department with syncopal attacks. Two months prior to the presentation, she had started treatment with rivaroxaban 15 mg/day and a week before the event, she had started on celecoxib 200 mg/day for her left knee arthritis. On physical examination, she had decreased respiratory sound on the left lower lung. A 12-lead ECG revealed sinus tachycardia with non-specific ST-T changes. A chest X-ray showed a large amount of pleural effusion in the left lung along with cardiomegaly, with trachea deviation to the contralateral side. A chest CT revealed bilateral pleural effusion (a massive amount in the left hemithorax) along with a moderate amount of pericardial effusion. The Hounsfield units of the right side pleural effusion, left side pleural effusion and pericardial effusion were 27.1, 32.5 and 26.0, respectively. A week before the presentation, her Hb level was 11.0 g/dL. and on admission decreased to 8.5 g/dL. Her Hb dropped to 6.1 g/dL on day 2, she was transfused with 4 units of packed RBCs. Subsequently, thoracentesis was performed, resulting in approximately 530mL of heavily blood stained fluid. The pleural fluid analysis showed a haematocrit (Hct) of 16.6%, acid-fast bacilli smear for tuberculosis and bacterial gram-stain. Her serum Hct was 22.9% at the time of thoracentesis, and the ratio of pleural to serum Hct was 72.5%, which confirmed the diagnosis of haemothorax. Similar Hounsfield units of the pericardium and bilateral pleural effusion were suggestive of haemopericardium and bilateral haemothorax. The woman was treated with factor-VIII-inhibitor-bypassing-fraction [Factor eight inhibitor bypassing agent] to reverse the effect of the rivaroxaban. However, the left side haemothorax increased over the following days and a litre of bloody pleural effusion was drained with the insertion of a catheter. Subsequently, the catheter was removed after 7 days. Unfortunately, she suffered acute renal failure and pneumonia, and died from septic shock. Yu J-H, et al. Spontaneous bilateral haemothorax with haemopericardium secondary to rivaroxaban. Journal of Clinical Pharmacy and Therapeutics 45: 1175-1178, No. 5, Oct 803504473 2020. Available from: URL: http://doi.org/10.1111/jcpt.13116

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