Spontaneous Extrapleural Hematoma in a Hemodialysis Patient Receiving Anticoagulation: A Rare Cause of Acute Chest Pain

Extrapleural hematoma is a rare condition defined by blood accumulation between the parietal pleura and the endothoracic fascia. It is most commonly traumatic, whereas spontaneous cases remain exceptional. We report a case of a 60-year-old patient undergoing chronic hemodialysis and with documented anticoagulant exposure who presented with acute chest pain and dyspnea. Chest computed tomography (CT) revealed a right-sided extrapleural hematoma with characteristic imaging features, including lenticular morphology, spontaneous high attenuation on non-contrast CT, and displacement of extrapleural fat, associated with moderate right pleural effusion. Contrast-enhanced CT showed no active contrast extravasation. The patient was managed conservatively with a favorable clinical evolution. This case highlights the diagnostic value of CT in identifying extrapleural hematoma, distinguishing it from pleural collections, and guiding conservative management in clinically stable patients without evidence of active bleeding.