Development of left-sided massive pleural effusion, as revealed by comparison of follow-up chest x-ray with initial x-ray (Fig. 3), was confirmed by follow-up chest CT, which showed left-sided massive pleural effusion with collapse of the left lung and slightly increased density of pleural effusion (Fig. 4). Based on these findings, hemothorax was highly suspected. Videoassisted thoracoscopic thoracotomy was performed, during which
2400 mL of bloody fluid was drained from the left thoracic cavity and extracorporeal membrane oxygenation was initiated. Two days later, further bilateral pulmonary artery thromboembolectomies were performed, and an inferior vena cava filter was inserted. After 1 week of intensive care unit stay, the patient was transferred to the general ward and then discharged 1 month later without further complications. Overall, hemothorax is rarely observed following anticoagulation
therapy. The few documented cases of spontaneous hemothorax associated with coagulopathy have primarily been attributed to anticoagulant administration for treating thromboembolic disease