Hemothorax and Hematocele: Unusual Presentations of Vitamin K Deficiency Bleeding Disorder

Abstract

Sir, Hemothorax and hematocele are rare manifestations of Vitamin K deficiency bleeding disorder in newborns; hematocele being hitherto unreported in English literature. An exclusively breastfed, 1-mo-old male infant presented with sudden onset respiratory distress associated with swelling of left scrotum. Examination revealed that the infant was in shock with severe pallor, tachycardia, tachypnea, reduced air entry and vocal resonance over right hemithorax with dull percussion note on the same side. Heart sounds were normal with no organomegaly. The left scrotal sac was enlarged with a mild bluish hue (Fig. 1); the swelling being irreducible. Investigations showed a negative septic screen with hemoglobin 5 g/dl and platelets 200,000/cumm. Chest radiograph showed homogenous opacity involving right hemithorax with mediastinal shift to the left. Needle thoracentesis revealed a bloody tap and 100 ml of blood was drained by a water-seal drainage tube. Ultrasonography of the scrotum confirmed the presence of hematocele in left testis. Prothrombin Time (PT) and activated Partial Thromboplastin time (aPTT) were markedly deranged. Fibrinogen levels were normal. A review of history revealed no history of maternal intake of any drugs antenatally and no bleeding diathesis in the family. The patient had not received vitamin K at birth. He was managed with oxygen, intravenous fluids, red cell transfusion and intravenous vitamin K. Symptoms resolved within hours. A repeat PT and aPTT after 8 h showed normalization of values. Considering the clinical picture of hemothorax and hematocele in an exclusively breast fed baby with normal septic screen, in the context of deranged aPTT and PT which normalized after administration of vitamin K, a diagnosis of Late onset Vitamin K Deficiency Bleeding (VKDB) of the newborn was made. VKDB is characterized by hemorrhagic manifestations with INR≥4 with normal platelet and fibrinogen level. Diagnosis is confirmed by rapid (within 2 h) normalization of coagulation V. Aggarwal :K. Mishra : B. Rath : S. Chaudhary : P. Kumar Department of Pediatrics, Lady Hardinge Medical College and associated Kalawati Saran Children’s Hospital, New Delhi, India