Spontaneous Chest Wall Hematoma in a Hemodialysis Patient: A Case Report

Background/Objectives: Spontaneous chest wall hematomas are rare but potentially life-threatening complications, particularly in patients with multiple comorbidities such as those undergoing hemodialysis. This case report aims to highlight the significance of early diagnosis and appropriate management in preventing complications associated with this condition. Methods: We report the case of a 79-year-old man with end-stage renal disease on hemodialysis, presenting with a large spontaneous hematoma (18.7 × 13.1 × 9.6 cm) in the right upper chest wall. Initial interventions, including diagnostic imaging and transarterial angiography, did not detect active bleeding. Surgical exploration revealed bleeding from a branch of the lateral thoracic artery, which was managed through vessel ligation and hematoma drainage. Results: The hematoma was successfully managed through surgical intervention, with no postoperative complications such as infection, recurrent bleeding, or wound issues. The patient's recovery was uneventful, and he was discharged in stable condition. This case underscores the role of microvascular fragility and uremic coagulopathy in the development of spontaneous bleeding in hemodialysis patients. Conclusions: This case emphasizes the importance of timely recognition and individualized management of spontaneous soft tissue bleeding in hemodialysis patients. Surgical intervention is necessary for large hematomas or cases of hemodynamic instability to ensure hemostasis and mitigate complications.