Cardiac tamponade due to apixaban therapy in patient with unknown pericardial hemangioma

A 78-year-old woman was hospitalized, in our Pulmonology
Department, for worsening of resting dyspnea.
She had a recent history of pulmonary embolism secondary
to deep vein thrombosis. She was also affected by arterial
hypertension in therapy with delapril/indapamide
30/2.5 mg OD.
For the recent pulmonary embolism and the thrombosis,
she was initially treated for 25 days with enoxaparin [8000
UI s.c. BD--the dosage of LMWH was assessed according
to the patients constitution; weight 67 kg; renal function
index (eGFR) 112 ml/min per 1.73 m2] and, 5 days before
the onset of respiratory symptoms, she started apixaban
(5 mg 2 cpr BD) with the creation of the therapeutic plan
according to the national health rules, after having completed
an instrumental follow-up with chest X-ray study
and a perfusion lung scan.