Spontaneous muscle bleeding in patients with COVID-19 (analysis of own observations)

Introduction. Purpose. Study the mechanisms of occurrence and the imaging characteristics of spontaneous intramuscular hemorrhage in patients with COVID-19 viral pneumonia.Methods. The anamnesis, clinical and laboratory data and the results of computed tomography of 28 patients with spontaneous intramuscular hematomas associated with viral pneumonia were analyzed.Results. According to computed tomography, 36 spontaneous hematomas of muscles and soft tissues of various localization were diagnosed (7 patients had multiple hematomas), mainly in women, the average age of the patient was 75 years. No arterial sources of bleeding were detected by contrast enhanced computed tomography. There was no correlation between the volume and timing of the development of hematomas with anticoagulant therapy. The appearance of 57.1% of hematomas after the 21st day from the onset of the disease was noted. In dynamics, the volume of hematomas didn’t increase and did not require surgical intervention.Conclusion. Spontaneous intramuscular hemorrhage is a rare complication of COVID-19 viral pneumonia, leading to an unfavorable outcome only with a large volume of hematoma. Surgical treatment of hematomas is not required. The development of spontaneous hematomas can be influenced by both the prescribed anticoagulant therapy and the direct effect of the SARS-CoV-2 virus on the blood coagulation system and the endothelium of the wall of small vessels.