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We report a case of acute hemothorax caused by a left internal thoracic artery pseudoaneurysm rupture in a patient with neurofibromatosis type I, which was successfully treated with endovascular coil embolization.
Although splanchnic artery aneurysms are uncommon and remain mostly asymptomatic, they are associated with a high mortality rate when they rupture. We discuss the case of a 66-year-old woman who had successful embolization of a left gastric artery aneurysm after presenting with acute chest pain and the unusual computed tomography findings of hemothorax and hemomediastinum. To our knowledge, only one other similar case has been published in the literature.
We report two patients with alcoholic pancreatic pseudocyst which communicated to the mediastinal space through the aortic hiatus, in one patient resulting in hypotensive shock due to hemothorax, and in the other, resulting in esophagobronchial fistula via the mediastinal cyst. The first patient was successfully treated by radical resection of the pancreatic body and tail, and the spleen, with an ultrasonic scalpel, although inflammatory changes caused by pancreatitis were so prominent that the splenic vein was occluded. The second patient could not be treated surgically, because the superior mesenteric vein had been occluded by chronic pancreatitis; he died of respiratory failure and sepsis due to aspiration pneumonia, despite receiving medical treatment.
The rupture of an aneurysm of the descending thoracic aorta into the right thoracic cavity is a comparatively rare event, and it is very difficult to establish a diagnosis immediately and rescue such patients. We describe herein the successful surgical treatment of a patient with this life-threatening emergency by initiating immediate cardiopulmonary bypass. It is mandatory to drain the right thoracic bleeding through a left thoracotomy without delay to release the tension hemothorax. Furthermore, it is necessary to evacuate the right thoracic hematoma through a right thoracotomy because complete removal o f a hugh hematoma through a left thoracotomy cannot be effectively achieved.
We reviewed 395 patients with isolated hemo- or hemopneumothorax from penetrating injuries. All patients were treated with immediate insertion of a chest tube and drainage of various amounts of blood up to 1,500 ml. Forty-five patients (11 percent) were in hemorrhagic shock on admission to the hospital emergency room, and all were resuscitated with volume replacement. Twenty-one patients (5.3 percent) whose blood pressure decreased again were found on exploration to have lacerated internal mammary or intercostal arteries or major lung lacerations extending into the hilus. All other patients were treated aggressively with chest tubes, aspiration of residual blood and fibrinolytic enzymes until the lung was fully expanded. We conclude that the clinical course of patients with hemothorax after insertion of a chest tube should determine whether exploration is necessary or whether nonoperative treatment should continue.
Enzymatic debridement of the pleural cavity for retained hemothorax or empyema is a frequently overlooked option. Thirteen of fourteen patients (93%) with retained pleural collections underwent successful enzymatic debridement and tube drainage with purified streptokinase injections. The average increase in chest tube output following streptokinase injections was 158%. No significant adverse reactions occurred. One patient required thoracotomy when streptokinase therapy failed. Two others had successful resolution of their pleural collections but required thoracotomy for other indications. There were two deaths (14%), which were unrelated to the use of streptokinase or residual empyema. Intrapleural streptokinase is a safe, effective means of removing retained proteinaceous collections in the pleural space. It is a useful adjunct to chest tube drainage and may obviate the need for more invasive procedures.
We report a case of seromuscularis rupture of the oesophagus occurring after an episode of vomiting and revealed by a left hemothorax. Diagnosis was established at thoracoscopy and was related to the nosologic setting of post-emetic syndromes. All unusual pleuropulmonary symptoms after vomiting must make evoke this diagnostic hypothesis.
Intralobar sequestration is a rare abnormality usually diagnosed at later age after a history of recurrent pulmonary infections. We present a case of a 55-year-old man in whom both hemoptysis and massive hemothorax were the initial presenting symptoms. This report shows that intralobar sequestration can have a dramatic course of disease, and for this reason resection of the sequestered tissue should be considered in all patients.
OBJECTIVES: A prospective analysis was conducted to define the incidence of occult pneumothorax (OPX), delayed pneumothorax (DPX) and delayed hemothorax (DHX) and to propose an algorithm for surveillance. METHODS: During the last 2 years 709 consecutive patients who did not fulfill the indications for intrahospital management were examined at our emergency department for blunt thoracic injury. All patients were subjected to expiration posteroanterior chest radiograph (eCXR) and were scheduled for reevaluation after 24, 48 h and at 7, 14 and 21 days. RESULTS: OPX was present in 28 patients (4%) detected only with eCXR on admission, 14 patients developed DPX (2%) at 24-48 h later, and 52 patients presented up to 14 days later with DHX (7.4%). Of all DHX 42 (80.7%) required chest tube drainage, eight thoracentesis (16%) and only two (4%) were subjected after 1 month to decortication. No related morbidity was recorded. All the patients with the DHX had at least one rib fractured. Only one death among the DHX patients was documented. CONCLUSIONS: A safe algorithm is recommended: eCXR for every patient who suffered blunt thoracic injury with at least one rib fracture detected and is treated as an outpatient or in case his/her compliance with the reevaluation schedule will be suboptimal. Close follow-up is also suggested since these entities do exist, cannot be ignored and their treatment is early evacuation of the pleura cavity.
Pleural effusions have not been reported after percutaneous cryoablation of the kidney. In our initial experience, we identified and treated two patients who had the complication of hemothorax after percutaneous cryoablation for renal malignancy. The occurrence of pleural effusions is frequently related to technical aspects of the procedure. The pathogenesis of this serious complication is discussed and preventive measures are highlighted.
A 6-year-old girl with hereditary multiple exostoses presented with spontaneous hemothorax and pericardial effusion. Chest computed tomographic scan showed left-sided costal exostoses protruding into the left side of the chest. She underwent successful thoracoscopic resection of 3 left rib exostoses and made a full recovery. This report illustrates this rare clinical scenario and reviews the previously published reports of this complication of costal exostoses.
We describe a 27-year-old male patient suffering from beta-thalassemia intermedia who presented with a nontraumatic spontaneous hemothorax due to extramedullary hemopoietic foci. In reviewing the literature, four similar reports were found. The details of this unusual entity are discussed.
We report a very rare case of acute aortic dissection of the ascending aorta, which ruptured to the left pleural cavity through the left-side congenital pericardial defect. A preoperative computed tomographic scan and a roentgenogram showed localized dissection of the ascending aorta and severely deteriorating left hemothorax, which required emergency operation. Intraoperative findings revealed the ruptured aortic dissection of the ascending aorta and the defect at the left-side pericardium, and a graft replacement of the ascending aorta was performed. It was considered that congenital pericardial defect complicates the diagnosis in a case of catastrophic intrapericardial hemorrhage.
Ewing sarcoma is a relatively uncommon malignant bone neoplasm that usually occurs in children and young adults and involves the major long bones, pelvis, and ribs. Primary diaphragmatic Ewing sarcoma is extremely rare. To the best of our knowledge, only three cases of primary Ewing sarcoma of the diaphragm have been reported. A 12-year-old girl presented spontaneous occurrences of the right hemothorax. After drainage, a roentgenogram film, computed tomography, ultrasonography, and magnetic resonance image showed a giant mass on the right diaphragm. Primary diaphragmatic tumor was resected totally by right posterolateral thoracotomy, and histologically, an extraskeletal Ewing sarcoma was identified. The patient received adjuvant radio-chemotherapy, and there was no evidence of disease 10 months after the operation. Although extremely rare, extraskeletal Ewing sarcoma should be kept in mind in the differential diagnosis of diaphragmatic soft tissue tumors.
Massive hemothorax developed in a 58-year-old man 12 hours after a left pneumonectomy. The source of bleeding was a tear in the pulmonary vein stump caused by a titanium clip that had been used during mediastinal lymphadenectomy. Postoperatively, the clip progressively sawed through the vascular wall of the pulmonary vein due to friction during the cardiac cycle.
We report a case of life-threatening hemothorax caused by rupture of a left thyrocervical trunk aneurysm and arteriovenous fistula in a patient with type I neurofibromatosis. This lesion was treated with endovascular coil embolization.
BACKGROUND: Most patients with extratubal ectopic pregnancies present with vaginal bleeding and lower abdominal pain. We report a case of an extratubal ectopic pregnancy with extra-abdominal manifestations. CASE: An ectopic pregnancy implanted on the diaphragm resulted in spontaneous hemothorax due to trophoblastic invasion into the pleura. Thoracoscopic excision followed by actinomycin D chemotherapy provided successful resolution of the ectopic pregnancy. CONCLUSION: Abdominal pregnancies may have bizarre clinical presentations.
Percutaneous renal biopsy is a routine procedure with a low complication rate. We report a patient who developed shock and respiratory distress secondary to hemothorax following a fluoroscopically guided biopsy.