Epidural hematoma after total knee arthroplasty in a patient receiving rivaroxaban: A case report

Rivaroxaban, a factor Xa inhibitor, is one of the newly developed direct oral anticoagulants (DOAC). In recent times, it has been increasingly used in the prevention of pulmonary embolism in patients undergoing orthopedic surgery. This report describes a case of epidural hematoma in an elderly patient who underwent combined spinal epidural anesthesia for total knee arthroplasty; the patient received rivaroxaban postoperatively for 7 days to prevent pulmonary embolism. Additionally, the epidural hematomas developed on the 5th postoperative day but the patient recovered well with conservative treatment. Although rivaroxaban has a low need for monitoring and is easily administered, the guidelines should be carefully checked for the postoperative administration schedule in patients undergoing regional anesthesia. In addition, rivaroxaban should be used with caution, especially in elderly patients.

Primary Conjunctival Epithelial Cyst in the Orbit

PURPOSE: To report a case of a primary conjunctival epithelial cyst in the orbit. CASE SUMMARY: A 60-year-old woman was referred for evaluation of proptosis of the left eye, which had developed about 2 years earlier. Upon initial examination, a movable mass was palpated in the medial aspect of the left orbit. Magnetic resonance imaging of the orbit showed a 2.5 cm-sized, ovoid, cystic mass located between the left eyeball and the medial wall of the orbit. Excisional biopsy of the orbital mass was performed. The orbital mass was a well-circumscribed cystic lesion, adherent to the medial rectus muscle. Histological examination revealed that the cyst was lined with multiple layers of cuboidal epithelium with goblet cells. A diagnosis of primary conjunctival cyst was made. CONCLUSIONS: The possibility of primary conjunctival cyst should be considered in the differential diagnosis for an orbital cystic mass.