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Endometriosis is a common cause of chronic pelvic pain and infertility affecting women of reproductive age, but the disease in rare conditions may be extragenital so may be present with a variety of symptoms. This is a report of an unusual case of pelvic endometriosis that presented with a recurrent hemothorax.
Angiomatosis is a rare, benign but clinically extensive and serious vascular lesion of soft tissue. Hereby, we report a case of diffuse angiomatosis of mediastinum, presenting with hemomediastinum and bilateral massive hemothorax in a 19-year old boy. On medical imaging, mediastinal widening along with enhanced small vessels and capillaries were detected. On operation, hemorrhagic sponge-like vascular tissue patches were seen extensively in pericardium, pleura, lymph node and thymus as well. The lesion was debulked. The pathologic evaluation revealed characteristic features of soft tissue angiomatosis involving thymus, lymph node, pleura, pericardium and its fibrofatty tissue. Diffuse angiomatosis should be considered for differential diagnosis of vascular lesions of anterior mediastinum.
A 10.8-year-old, spayed female toy poodle presented with an esophageal foreign body. The foreign body was removed endoscopically, and a gastrostomy tube was placed to provide nutritional support during esophageal healing. The gastrostomy tube was later removed by endoscopic retrieval of the bulb through the esophagus. Immediately afterward, the dog developed hemothorax and eventually died. It was determined that many small arterial branches were avulsed from the aorta. The involved sections of aorta histopathogically evidenced medial necrosis, which was believed to be related to a prior disruption of blood flow through the vasa vasorum.
Spontaneous mediastinal hematoma is rarely seen in hematologic malignancy. We report a case of chronic myeloid leukemia initially presenting with spontaneous hematoma and hemothorax. In addition to a detailed history, computerized tomography of the chest is important in analyzing whether an anterior mediastinal mass lesion is present. Magnetic resonance imaging is helpful in confirming the nature of a mediastinal hematoma. Trauma, vascular disease and coagulopathy should first be ruled out when making a diagnosis of spontaneous bleeding in the thorax. In our patient, the mediastinal hematoma regressed spontaneously after three months. Leukemia should be considered in the differential diagnosis of spontaneous mediastinal hematoma. In leukemia patients with spontaneous mediastinal hematoma, supportive observation and close follow-up may be better than surgery, unless massive hemorrhage or active bleeding in the thorax is suspected.
Hemangiopericytoma is an unusual soft tissue tumor. A 54-year-old man presented with sudden onset of chest pain and dyspnea for 1 day. The initial chest x-ray showed a massive left pleural effusion. A contrast-enhanced computed tomographic scan of the chest showed a homogenously enhanced mass in the intrathoracic extrapulmonary space. A tube thoracostomy was performed and hemothorax was confirmed. A posterolateral thoracotomy was performed and a tumor in the parietal pleura of the left chest wall was resected. Grossly, the resected tumor arose from the parietal pleura, and the cut surface was elastic, soft, and pale yellow. There were several cystic formations and hemorrhages. Based on histologic findings, hemangiopericytoma with lower grade malignancy was diagnosed. The patient was alive and free from tumor recurrence 1 year after surgery. Intrathoracic extrapulmonary hemangiopericytoma is extremely rare, and surgical excision is the treatment of choice. Adjuvant chemotherapy or radiotherapy is indicated because of the high risk of recurrence and potential malignancy.
A 70-year-old woman with aortic regurgitation was scheduled for aortic valve replacement. After induction of anesthesia resistance was encountered when attempting to remove the guide wire with a sheath dilator prior to insertion of a pulmonary artery (PA) catheter through the right internal jugular vein. Ten hours after catheter insertion, chest X-ray examination in ICU showed poorly delineated right lung field, and hemothorax was suspected, as a large amount of fluid was also seen draining from the chest drain tube. Twenty two hours after catheter insertion, we opened her chest and found that the superior vena cava (SVC) had been perforated. After surgical closure of the hole on the SVC, the hemodynamics because stabilized and active bleeding was controlled. The patient was subsequently discharged from the hospital without any further complications. This perforation was thought to be caused by carelessness during insertion of the PA catheter. To prevent serious complications, such as perforation of the great vessels or heart by a catheter, the results of the present case suggest that careful attention is required during catheterization, especially when resistance is encountered.
BACKGROUND: Small congenital diaphragmatic defects are usually occult, but can present as a problem in patients with increased abdominal fluid as unilateral massive hydrothorax. We present a unique case presentation of a small congenital diaphragmatic defect. CASE REPORT: A 79 female immediately postoperatively developed a hydrothorax following low anterior resection for rectal cancer. The hydrothorax turned out to be due to an intrabdominal bleed in a patient with a previously undiagnosed congenital diaphragmatic hernia. The respiratory ball value mechanism worked as a pump to move blood from the abdomen to the chest and caused a tension hemothorax. RESULTS: Surgeons should be aware that a post operative hydrothorax could be associated with an intrabdominal complication of recent surgery. CONCLUSIONS: A small occult congenital diaphragmatic defect and associated ball value mechanism may provide an unexpected but clinically significant communication between the abdominal and thoracic cavities.
Residual post-traumatic hemothorax (RPTH) occurs in 3 to 8 per cent of patients with tube thoracostomy and may cause serious infectious complications. Surgical evacuation is recommended, and thoracoscopic evacuation (THEVA) tends to replace open thoracotomy for this purpose. The objective of this study is to evaluate the optimal timing, safety, and efficacy of THEVA. Over 5 years patients with tube thoracostomy for trauma who had unresolved opacities on plain chest radiograph were evaluated by CT. If the residual fluid volume was estimated to be more than 500 mL3 on CT the patients were offered THEVA. Unstable patients were excluded. A score ranging from one (easy) to three (difficult) was used to grade the difficulty of the operation according to the attending surgeon's perception. Of 1728 chest trauma patients 143 (8%) were evaluated by CT for persistent opacity on plain film, 31 (1.8%) were found to have RPTH, and 24 (1.4%) were eventually taken for THEVA at 3.5+/-2 days after admission. Low oxygen saturation (less than 94%) was found in 58 per cent of patients before THEVA but in only 25 per cent after THEVA (P = 0.02). The majority of chest tubes (75%) were removed within 4 days of the operation. Two patients required conversion to thoracotomy. THEVA done within 3 days of admission was associated with a lower operative difficulty score, shorter hospital stay, and a trend toward shorter intraoperative time compared with THEVA done after 3 days of admission. All patients had effective resolution of their radiographic opacities after THEVA. Three patients developed a complication (urinary tract infection, pneumonia, and persistent air leak). We conclude that patients with significant RPTH and without major physiologic compromise are appropriate candidates for THEVA. The procedure is safe, evacuates PRTH effectively, and improves the respiratory function of affected patients. Ideally it should be performed within 3 days of admission.
Aneurysm of the peripheral pulmonary arteries is rare. Rupture of pulmonary artery aneurysms manifesting as recurrent hemoptysis with exsanguination is well recognized. We report the case of a young woman who presented with massive hemothorax and shock at the sixth month of pregnancy due to a ruptured lingular artery aneurysm. She was treated with selective coil embolization of the lingular artery to achieve hemostasis. Subsequently, clot evacuation from the pleural space was done. This case is reported for its unsuspected presentation, rarity and to highlight the use of catheter coil embolization to achieve control of bleeding and exclusion of the aneurysm from the pulmonary circulation.
Analysis of 102 cases of coagulated hemothorax (CH) are presented: 32--after penetrating wounds and 70--after closed chest injury. In 57% patients with chest wounds and 72% patients with closed injury the cause of CH was to applying late for medical care. Diagnostic value of X-ray, ultrasonic methods, CT and pleural puncture was studied. Depending on the patients state severity, CH volume and stage of it formation conservative treatment, streptase administration, thoracoscopy and thoracotomy with pleurectomy and lung decortication were performed. Lethality was 2.9%.
The paper deals with the ultrasound study of the hemothoracic cavity in pulmonary tuberculosis patients undergone pulmonectomy. Ultrasound study provides objective data on the time course of processes occurring the hemothorax operated on and controls the development of fibrothorax, such as the formation of effusions, in all its details.
An estimation of the postoperative course after pneumonectomy in 328 patients, depending on the character and rate of distinguishing the pleural fluid, is given. The development of collapsed hemothorax and early (during the first week) fibrinothorax is predominantly related with separation of massive pleural adhesions, it aggravates the postoperative period and predisposes to the development of pleural empyema. Rethoracotomy with the removal of clots especially in later terms fail to prevent this complication. Intrapleural injections of fibrinolytic drugs is found to offer more perspectives.
A 19-year-old woman who presented with right-sided hemothorax was diagnosed to have gestational trophoblastic disease with pleural metastasis. A CT scan of the chest revealed a pleural mass and serum Beta-subunit of HCG was high. After treatment the hormonal level became normal and the patient remains asymptomatic.
Various biochemical parameters of pleural fluid have been employed to identify malignant effusions. However, many of them are also elevated in patients with nonmalignant conditions. We report on a patient with traumatic hemothorax, showing high pleural fluid concentrations of ferritin, tissue polypeptide antigen, and cancer antigen 125. This patient's pleural fluid also contained high levels of bilirubin and many macrophages containing phagocytized red blood cells, suggesting a local metabolism of hemoglobin. Our case confirms that some tumoral markers can give false positive results and suggests that their significance must be evaluated differently in bloody pleural effusions as compared with non-bloody pleural effusions.
Extralobar pulmonary squestration is a rare anomaly of abnormal pulmonary tissue without any communication to the bronchial tree and that receives blood supply from anomalous systemic arteries. We presented a case of massive hemothorax caused by bleeding inside extralobar pulmonary sequestration in an 34-year young man on anti-coagulation therapy because of built-in mechanic aortic valve. Surgical treatment was decortication and sequestrectomy after ligature of the aberrant vessels. We reviewed the literature on this topic and did not found any report about similar case.
Central venous catheterization is extensively used in unstable patients who need hemodynamic monitoring and in patients who require prolonged treatment such as, chemotherapy, antibiotics therapy, parenteral nutrition, or temporary hemodialysis. Subclavian vein catheterization is the preferred approach for hemodialysis, especially as it does not restrict the patient. Most of the complications related to this procedure are insignificant, however, occasionally they may be life threatening and require surgical intervention. We present a case study of a 77-year-old woman suffering from chronic renal failure. A subclavian catheter was inserted, and the patient started hemodialysis. Three weeks later, during hemodialysis, she complained of right upper abdominal and right chest pain. Chest X-ray showed a moderate to large right pleural effusion, with pleurocentesis confirming the presence of hemothorax.
A 37-year-old man was admitted to our hospital. The patient noted sudden right back pain after coughing before 1 hour. Loss of consciousness was occurred in an ambulance. Chest X-P revealed whole fluid in the right chest. Enhanced chest computed tomography (CT) revealed extravasation of contrast media into the pleural cavity from the right chest wall. Thoracentesis was performed to relieve dyspnea and 2,000 ml of blood was removed. Then hemoglobin count was dropped to 3.8 g/dl. At thoracotomy whole blood was sucked about 3,900 ml. Bleeding point was found at third intercostal vein. The vein was knotted and sutured by prolene thread. The bleeding lesion was no inflammation and no string like tissue. We report a case of idiopathic hemothorax and enhanced chest CT was useful for diagnosis of bleeding lesion of pleural cavity.
Thoracic trauma usually results in severe injury and is associated with a high rate of mortality, either due to the trauma itself or due to trauma-related causes. Early diagnosis and treatment of chest injuries is a very important determinant of the outcome. Video-assisted thoracic surgery (VATS) is gaining increasing importance as a diagnostic and therapeutic procedure. Especially in cases of traumatic hemothorax, this new method is very advantageous because of its simplicity, safety and efficacy in the acute phase of haemorrhage, after stabilisation of the patient, as well as in the treatment of complications.