Massive hemothorax due to intercostal arterial bleeding after percutaneous catheter removal in a multiple-trauma patient: A case report

BACKGROUNDIntercostal arterial bleeding is unusual complication of percutaneous chest procedures. However, intercostal arterial bleeding is likely to result in critical complications such as abnormalities in vital signs, hypovolemic shock, and death due to massive bleeding. Therefore, it is very important to establish the diagnosis of intercostal arterial bleeding and to initiate treatment.CASE SUMMARYWe report a case in which a 59-year-old woman who was hospitalized at intensive care unit with multiple trauma had a massive hemothorax after the removal of a percutaneous catheter. She sustained a refractory right pleural effusion due to biloma caused by a traumatic injury to the liver, despite persistent intraperitoneal drainage. As a result, atelectasis persisted in the dependent portion of the right lung. Therefore, we performed right percutaneous catheter drainage (8.5-F pigtail catheter) for pleural effusion drainage at the 7^th intercostal space. After percutaneous catheter removal, portable chest radiography and vital signs of the patient assisted in establishing a diagnosis of intercostal arterial bleeding. Intercostal arterial bleeding was also confirmed using transarterial angiography; and embolization was performed. The patient’s condition progressively improved, and no further intervention was required.CONCLUSIONMassive hemothorax is a rare complication of percutaneous catheter removal. Clinicians should carefully examine and diagnose patients to improve prognosis. And interventional selective angiography may be a feasible and minimally invasive treatment for intercostal arterial bleeding control.     

上中胸椎骨折并发血胸的护理

胸椎骨折因其自身解剖特点和创伤机制，常合并严重胸外伤和脊髓损伤。胸椎骨折后由于相应的脊神经受损影响肋间肌活动，可引起呼吸抑制，病情危重常危及患者生命。我院2003年1月～2009年10月共收治胸椎骨折并发血胸患者16例，现将护理体会总结如下。     

Learning from Mistakes: Femoral Vein Cannulation-An Unusual Complication or a Blessing in Disguise!!!

Femoral vein cannulation is often used in resuscitation and in critical care units. We report an uncommon complication of femoral vein counterpuncture-peritoneal puncture and the consequences which led us to diagnose a missed traumatic diaphragmatic rupture.     

45例肺叶切除术后并发凝固性血胸的处理

目的:探讨肺叶切除术并发胸腔凝固性血胸的诊疗。方法:对2006年5月～2009年6月45例肺叶切除术并发胸腔凝固性血胸采用尿激酶胸腔内注入进行回顾性总结分析。结果:39例患者经用尿激酶胸腔内保留注射,胸内血块消失,余肺复张良好,有效率达86%,6例无效,需要再次开胸清除血块。结论:术后胸腔出血是肺叶切除手术的常见的并发症。往往通过胸腔闭式引流达到排出积血的目的,但是有部分病人因引流不畅,或是早期出血较快、较多形成血块。术后合理应用尿激酶胸腔内保留注入给药能起到很好的清除血块的作用。     

Erosion of the Nuss bar into the internal mammary artery 4 months after minimally invasive repair of pectus excavatum

The minimally invasive repair of pectus excavatum has become increasingly popular. Life-threatening complications have included bleeding and cardiac perforation. There have been a number of delayed cases of bleeding, many of which never demonstrated a clear source. We present a case of a delayed acute bleed from the Nuss bar eroding into the internal mammary artery 4 months after bar placement.     

Strategies in the management of penetrating cardiac trauma based on 14 surviving patients from a strife-ridden area

Background  Penetrating cardiac injury is one of the most life-threatening conditions. Most patients die before reaching the hospital and those that arrive alive must receive immediate surgical intervention based on a high index of suspicion. Methods  A retrospective study was conducted of 14 patients with penetrating cardiac trauma who were surgically treated, eight who underwent surgery in Israel and six who underwent surgery in Gaza, The Palestinian National Authority. The factors influencing survival, morbidity and mortality were evaluated and long term follow-up, clinical and demographic data were examined. Results  Fourteen patients underwent urgent surgery due to penetrating heart injury. Twelve patients were in shock on admission, at exploration 11 out of the 14 patients were found to be suffering from cardiac tamponade, eight patients out of the 14 were treated by chest tubes preoperatively due to a hemothorax and seven of these eight patients were also found to have a cardiac tamponade at exploration. None of the 14 patients suffered damage to the coronary arteries. In all patients, bleeding from the hole in the heart was controlled by digital pressure and then closed using Vicryl pledgeted polypropylene sutures. There were no cases of mortality or late morbidity in any of the patients. Conclusions  Cardiac tamponade and the absence of coronary vessel injury enabled successful early definitive management of penetrating cardiac trauma patients. Transferring the patient to the operating room without delay is the key to survival.     

电视胸腔镜在血胸处理中的作用

目的探讨电视胸腔镜手术(VATS)在血胸处理中的适应证和禁忌证.方法用VATS诊断和治疗血胸34例.其中12例为自发性血气胸,21例为创伤性血气胸,手术后血胸1例.结果平均手术时间52(25～130)min.术中从胸内平均清除血量1 460(400～3 400) ml.术后留置胸腔闭式引流管平均1.5(1～4)d.全组无手术死亡.无中转剖胸手术,亦无术后并发症.结论 VATS能彻底清除胸内积血和血凝块,并有效地止血和处理胸内合并损伤.尤其适应于自发性血胸、活动性血胸、凝固性或包裹性血胸以及并发化脓感染的血胸.     

一例肺吸血虫病引起机化性血胸病人的护理

肺吸虫病又称肺并殖吸虫病,我国主要有卫氏并殖吸虫和斯氏并殖吸虫2种,人因生吃、腌吃、醉吃溪蟹或喇蛄而感染,也可因饮用含有囊蚴的生水而受到感染。肺是卫氏并殖吸虫最易侵犯的脏器,肺吸虫病发病过程多缓慢,早期症状不明显,潜伏期不易确定,或长或短,多为1个月至1年,但最短只有2d,最长达10年之久。     

Hemothorax: an unusual complication of costal exostosis

We report a case of a spontaneous hemothorax in a 15-year-old girl because of costal exostosis. This possibly may have been provoked by a nontraumatic rupture of markedly dilated pleural vessels because of long-standing friction between the exostosis and the pleura. The authors conclude that exostosis of the rib is a rare cause of hemothorax in children and should be considered among possible etiologies in diagnosis.