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At least 163 records · Page 9Linked to original sources

Delayed onset of hemothorax: an unusual complication of subclavian access for hemodialysis.

Subclavian catheterization for acute hemodialysis has become routine in many institutions. Immediate complications of this technique are dramatic and easily recognized, whereas late complications are less common, frequently insidious and tend to be more severe. We report the delayed occurrence of a right hemothorax following two hemodialysis treatments with a left subclavian access. Pertinent literature is reviewed.

Catheterization↗

Hemorrhagic cardiomyopathy and hemothorax in vitamin K deficient mice.

The cause of a fatal condition characterized by hemorrhagic cardiomyopathy, hemothorax, and coagulation defects in hysterectomy-derived male mice was investigated. Microscopic heart alterations included multifocal hemorrhage and necrosis with variable degrees of acute inflammation and fibroplasia that were most severe in the region of the atrioventricular junction. A spontaneous outbreak was arrested by increasing menadione Na-bisulfite (vitamin K) in the feed to 20 ppm. The complete syndrome including hemorrhagic cardiomyopathy was readily reproduced in germ-free male mice given a vitamin K-free diet, and in conventional male and female mice given Warfarin in the diet. We concluded that the cause of this condition was vitamin K deficiency.

Animals↗

Video-assisted thoracic surgery for hemothorax following coronary artery bypass.

A 56-year-old man complained of dyspnea and cough 9 days after coronary artery bypass grafting. Chest radiography showed opacity and left lung collapse. Following removal of clots from the pleural cavity by videothoracoscopy, he recovered without further incident. Video-assisted thoracic surgery is a feasible and safe option in the management of early hemothorax.

Coronary Artery Bypass↗

Right hemothorax from leaking aortocoronary vein graft giant aneurysm.

Aneurysm of the saphenous vein aortocoronary bypass graft is a rare but potentially fatal complication of coronary artery bypass grafting (CABG). We report a case of an aneurysm of the saphenous vein aortocoronary bypass graft presented 7 years after redo CABG, with features of right atrial compression and right hemothorax. The patient was successfully treated surgically.

Aged↗

Massive hemothorax due to enlarging arteriovenous fistula in pregnancy.

A 37-year-old woman with hereditary telangiectasia suffered a life-threatening hemothorax due to an enlarging pulmonary arteriovenous malformation in pregnancy. This was treated by emergency right lower lobectomy and excision of arteriovenous malformations in the right middle and upper lobes, with no postoperative complications, and the subsequent delivery of a normal infant. Women with hereditary telangiectasia contemplating pregnancy should be screened for the presence of PAVM to anticipate complications.

Adult↗

Pulmonary blastoma presenting with massive hemothorax.

Pulmonary blastoma, a rare primary lung neoplasm occurring in both children and adults, is histologically distinct from other lung tumors. A patient is described who presented with massive and persistent hemothorax. Based on experience, it is possible that in advanced cases of this tumor, more vigorous chemotherapy is needed against both histologic elements.

Adult↗

Concurrent catamenial hemothorax and hemopneumothorax.

We describe a case of catamenial hemothorax and hemopneumothorax occurring on both sides simultaneously; the patient responded remarkably with danazol therapy. To our knowledge, this is previously unreported in the literature.

Adult↗

Massive hemothorax associated with intrathoracic extramedullary hematopoiesis involving the pleura.

Intrathoracic extramedullary hematopoiesis rarely involves the pleura and is usually asymptomatic. We report a 73-year-old woman with myelofibrosis who had pleural involvement with extramedullary hematopoietic tissue that produced a massive hemothorax. Before the diagnosis of extramedullary hematopoietic tissue was established, sclerosis with tetracycline was attempted, which accelerated pleural bleeding and required surgical evacuation. The bleeding was ultimately controlled by low-dose radiation therapy.

Aged↗

Acute hypoxemic respiratory failure following intrapleural thrombolytic therapy for hemothorax.

Intrapleural instillation of thrombolytic agents has been useful in the treatment of hemothorax when thoracostomy tube drainage is unsuccessful. We present a patient who developed acute hypoxemic respiratory failure following the intrapleural instillation of both streptokinase and urokinase 24 h apart. Hypoxemia most likely resulted from a direct effect of the products of fibrinolysis on the pulmonary circulation.

Acute Disease↗

Hemothorax following uncomplicated sclerotherapy for esophageal varices.

Although pleural effusion as a complication of esophageal manipulation is well described in the literature, the fluid is usually nonhemorrhagic. We describe the first patient who had uncomplicated sclerotherapy with ethanolamine for esophageal varices, and on two occasions this patient developed left-sided bloody pleural effusion within 12-72 h after sclerotherapy. The effusion resolved spontaneously within 4 weeks. This case illustrates that hemothorax should be included in the pulmonary complications of sclerotherapy for esophageal varices.

Adult↗

Thoracoscopy for empyema and hemothorax.

Video-assisted thoracic surgery (VATS) has assumed greater importance in the management of pleural disease. Since 1990, we have performed VATS procedures to manage a variety of pathologic pleural processes in 306 patients. The 99 patients with complex empyemas or hemothoraces are the focus of this report. Seventy-six patients with complex empyemas (including 26 chronic) were approached with VATS after inadequate chest tube drainage. The causes associated with the thoracic empyemas were parapneumonic collections in 47, after hemothorax in 8, infected sympathetic effusions associated with intra-abdominal sepsis in 6, postresectional in 5, prolonged bronchopleural fistula following spontaneous pneumothorax in 4, chronic drainage of malignant pleural effusions in 4, and chronic drainage of pleural effusion in 2 patients undergoing chemotherapy. Ages ranged from 14 to 78 years. Sixty-three patients (83%) were treated with thoracoscopic drainage +/- decortication alone. Thirteen patients (17%) required subsequent thoracotomy for decortication, including 12 of the 26 (46%) chronic empyemas known to be greater than 3 weeks old. Chest tubes were removed 3.3 +/- 2.9 days postoperatively in 67 patients; 9 patients (12%) were sent home with empyema tubes. Postoperative hospital stay for these patients with empyema averaged 7.4 +/- 7.2 days. There were five deaths, all related to progressive sepsis from associated pneumonia (6.6%). Twenty-three patients underwent thoracoscopic evacuation of hemothoraces that resulted following open heart surgery in 6, thoracic trauma in 7, were iatrogenic in 7, and bleeding into malignant effusions in 3. All were successfully treated by thoracoscopic drainage and pleural debridement alone. Chest tubes were removed 2.8 +/- 0.5 days postoperatively and hospital stay averaged 4.3 +/- 1.9 days. There were no complications; one patient with a hemothrax (after heart transplant) died of unrelated causes. In our experience, VATS has been highly successful in the early management of empyemas and hemothoraces. Conversion to open thoracotomy must always be anticipated, especially when approaching chronic empyemas.

Adolescent↗

Extralobar sequestration presenting as massive hemothorax.

Pulmonary extralobar sequestration is a rare anomaly, usually diagnosed during the first months of life. A case of extralobar pulmonary sequestration in an adult, manifesting itself as massive hemothorax, is presented.

Bronchopulmonary Sequestration↗

Cardiac tamponade and contralateral hemothorax after subclavian vein catheterization.

A patient developed life-threatening cardiac tamponade and contralateral hemothorax after insertion of a subclavian catheter in the operating room. Contrast was infused through the catheter, demonstrating its malposition in the pericardial space. Contrast infusion was valuable in evaluating this complication of central line placement.

Cardiac Tamponade↗

Hemothorax due to rupture of a benign thymoma.

Non-traumatic hemothorax is rare and in the case we report was due to rupture of a benign thymoma. The clinical course of the patient suggested rapid intrathoracic bleeding and emergency surgery was required to make the correct diagnosis.

Hemothorax↗

Hemothorax as rare presentation of intralobar pulmonary sequestration.

In a patient with intralobar pulmonary sequestration the presenting feature was severe hemothorax caused by rupture of the anomalous artery. Only one previous case with this presentation was found in the literature. During operation for intralobar sequestration, the blood vessels of the anomaly must be clearly visualized, in order to avoid further complications. When the condition is suspected, angiography is mandatory for establishment of the diagnosis.

Adult↗