Rupture of an Ascending and Descending Thoracic Aortic Aneurysm Causing Tension Hemothorax: A Case Report

Background: A ruptured thoracic aortic aneurysm is a life-threatening condition and can lead to a tension hemothorax. Objectives: To describe the presentation and management of a case of a tension hemothorax. Case Report: An 84-year-old woman presented in respiratory distress and was found to have a tension hemothorax. The cause was the rupture of an ascending and descending thoracic aortic aneurysm. She was managed with intubation, mechanical ventilation, and chest tube placement with stabilization. Definitive operative repair was deferred due to the patient's comorbidities and wishes of the family. Conclusions/Summary: A tension hemothorax can result from an ascending and descending thoracic aneurysm, as this case describes. Emergent therapy is necessary as this is a life-threatening condition.     

A case of delayed hemothorax with an inferior phrenic artery injury detected and treated endovascularly

We report the rare case of delayed hemothorax (DHX) with an inferior phrenic artery (IPA) injury due to blunt thoracic trauma. Our case suggests that DHX almost always occurs early after injury, and endovascular treatment is an effective procedure for traumatic hemothorax including DHX.     

Diaphragmatic pain in pulmonary endometriosis

The diagnosis of pulmonary endometriosis is difficult and requires a high index of suspicion in patients with pelvic endometriosis. We have reported a case in which a history of periscapular pain associated with menses proved useful in delineating the cause of the hemothorax.     

Spontaneous Hemothorax,A Rare Face of Vertebral Osteochondroma

Background

Osteochondroma is the most common benign tumor of the bone. It is usually asymptomatic, but complications may result from mechanical injury to adjacent anatomic structures, such as the diaphragm and lung, when located intrathoracically.

Hemothorax Associated with Anticoagulation after Placement of Implantable Cardioverter Defibrillator: Possible Similarity to Postinfarction Dressler''s Syndrome

Massive hemothorax developed after placement of an implantable cardioverter defibrillator (ICD) in two patients who received postoperative anticoagulants. The possible relationship of this complication to polyserositis after ICD implantation is discussed as are the possible adverse sequelae of early anticoagulation after ICD implantation.     

Massive hemothorax after blunt transverse cervical artery injury

Background

Blunt injuries to the thyrocervical trunk or its branches are rare because these vessels are well protected and located deep in the neck. To the best of our knowledge, we describe the first case of a massive hemothorax after blunt injury to the transverse cervical artery.

Case Report

A 42-year-old man was brought to our Emergency Department after he fell from a height of 10 meters. On work-up, a massive left hemothorax with extravasation from the left transverse cervical artery and pelvic fractures were detected. Endovascular embolization was successfully performed. There was no evidence of direct injury to the neck, lung laceration, or significant vascular injury that might have caused the massive hemothorax. A shearing mechanism associated with sudden deceleration caused by the 10-meter fall might have caused the transverse cervical artery injury in our patient.

Conclusion

Consideration of injury to the thyrocervical trunk or its branches by the emergency physician will result in more frequent consideration and more timely diagnosis when there is no chest injury and massive hemothorax.     

Spontaneous hemothorax caused by concomitant low-dose rivaroxaban and itraconazole in a 95-year-old patient: case report and literature review

Although direct-acting oral anticoagulants (DOACs) decrease the bleeding risk compared with vitamin K antagonists (VKAs), DOACs might cause spontaneous hemothorax in very elderly patients, even at a very low dose. Interactions between drugs might increase the risk of bleeding. In this article, we report a case of a 95-year-old man who developed spontaneous hemothorax while taking rivaroxaban 2.5 mg twice daily, 3 days after concomitant use of itraconazole. Rivaroxaban was discontinued, and thoracentesis was performed to drain grossly bloody pleural effusion. To our knowledge, this is the first case report of spontaneous hemothorax that might have been caused by concomitant low-dose rivaroxaban and azole anti-fungal agents. This case highlights the potential risk of spontaneous hemothorax in very elderly patients while taking rivaroxaban and azole anti-fungal agents simultaneously. Special attention should be paid to interactions between drugs that might increase the risk of bleeding. Drugs that have competing metabolic pathways should be avoided. Closer monitoring, including testing for anti-Xa and additional reassessment, should be considered in high-risk patients.     

Spontaneous Hemothorax Complicating von Recklinghausen Disease: Case Report and Treatment Algorithm

BackgroundNeurofibromatosis type 1 (NF1) is generally a benign disease but has the potential for rare and fatal complications. Vascular signs and symptoms associated with NF1 are reported in only 1–3% of patients. Pulmonary complications have been rarely described in the literature and spontaneous rupture of a major thoracic artery is, however, extremely uncommon.Case ReportWe report the case of a patient with NF1 admitted to the emergency department for the management of a spontaneous life-threatening left hemothorax. The patient became hemodynamically unstable after thoracic drainage. Computed tomography angiography revealed extravasation at the level of the eighth intercostal artery. Digital angiography showed an intercostal aneurysm. Catheterization of the eighth intercostal artery was unsuccessful and an open surgery was finally performed.Why Should an Emergency Physician Be Aware of This?We highlight the importance of recognizing that patients with a benign disease like NF1 may present to the emergency department with a spontaneous life-threatening hemothorax. Immediate transfer for embolization is not always the best treatment management but thoracotomy is preferred in unstable patients.     

Stab wound of the neck with contralateral hemo-pneumothorax

A rare case of stab wound of the neck with contralateral hemo-pneumothorax with a mediastinal shift is presented. After tube thoracostomy and computed tomography, the patient had angiographic coil embolotherapy of transected internal mammary artery (IMA). Subsequently, neck exploration with the repair of sternocleidomastoid was done. The patient underwent decortication on the 11(th) post-operative day for persistent residual hemothorax. IMA transection most often occurs from ipsilateral parasternal stab wounds and rarely from iatrogenic trauma. It is important to recognize the presentation of this rare entity as appropriate aggressive diagnostic and therapeutic interventions may be warranted.     

创伤性血胸和气胸患者胸腔引流管径大小选择与预后的相关性

目的探讨胸腔引流管径的大小对患者预后的影响。方法回顾性分析2010年1月至2019年12月航天中心医院收治因胸部创伤而进行胸腔引流管置入的74例患者资料,评估患者特征与引流管的大小、额外置管的风险和并发症的相关性。结果74例患者置入胸管86根,77根引流管作为初始引流管(3例患者需要双侧引流),9根为额外放置的引流管(置管原因分别为残余气胸3例,残余血胸4例,残余血气胸1例,胸腔外放置不当1例),附加引流管的管径与初始引流管相比较,差异无显著性(P=0.19,95%CI:-1.62~4.95)。初始置管放置的大小与患者的性别、指征、呼吸状态(有无气管插管)、受伤机制无相关性;引流管的大小与患者的年龄、体重指数、修订后的创伤评分、损伤严重程度评分、适应证、胸部损伤简短量表评分无相关性。按引流管大小将患者分为≥14 Fr组和<14 Fr组,两组间需要额外插管、血肿/气胸残留、胸膜外放置不当的风险差异无显著性,不需要额外的导管或手术干预治疗导管阻塞或残留的血胸凝块。结论在胸部外伤患者中放置<14 Fr引流管,残余血肿/气胸和阻塞引流的风险并未增加,引流充分有效。     

Longest delayed hemothorax reported after blunt chest injury

Introduction

Blunt chest injury is a common presentation to the emergency department. However, a delayed hemothorax after blunt trauma is rare; current literature reports a delay of up to 30 days. We present a case of 44-day delay in hemothorax which has not been previously reported in current literature.

Bochdalek diaphragmatic hernia masquerading as pneumonia - a rare cause of Non-Traumatic Hemothorax

Hemothorax is defined as collection of blood in the pleural cavity. Massive hemothorax may result in severe respiratory distress. We present an extremely rare cause of non-traumatic hemothorax in a 3 1/2-year-old girl by Bochdalek diaphragmatic hernia (BDH), and that was initially misdiagnosed as pneumonia with massive pleural effusion. Hemothorax masks the clinical and X-ray findings of BDH that makes the diagnosis even more difficult. Delayed or incorrect diagnosis of BDH complicated with respiratory distress leads to the wrong decision-making and the subsequent management, which may result in significant morbidity and mortality. Accordingly, emergency physicians need to be aware of this extremely rare etiology when evaluating pediatric hemothorax in a busy emergency department.     

Spontaneous hemothorax in a patient with Osler-Weber-Rendu disease

We have reported a case of spontaneous hemothorax as a rare complication of Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia). Because of the possibility of confusion with pulmonary infarction and its attendant treatment with anticoagulants, physicians should be aware of possible hemothorax in Osler-Weber-Rendu disease.     

Intercostal artery laceration following thoracentesis

Intercostal artery laceration is an unusual complication following thoracentesis, and has been reported only in elderly patients. We report a case of a 78-year-old man who developed a massive hemothorax following thoracentesis. Post-thoracentesis radiograph revealed a substantial increase in pleural fluid, and emergency chest tube insertion identified the hemothorax. He underwent right thoracotomy for repair of the intercostal artery laceration.     

33例结核性脓胸合并血胸的围手术期护理

结核性脓胸合并血胸临床少见,常严重危及患者生命。对手术治疗33例结核性脓胸合并血胸患者进行回顾性分析,患者术后恢复良好,无严重并发症,全部治愈出院。手术成功与否在很大程度上取决于围手术期的护理质量,做好患者及家属相关知识宣教和护理,提高治疗效果。     

Hemothorax and retroperitoneal hematoma after anticoagulation with enoxaparin

A 58-year-old woman with chronic obstructive pulmonary disease had spontaneous bilateral hemothorax and a retroperitoneal hematoma after 4 days of anticoagulation therapy with enoxaparin (1 mg/kg subcutaneously every 12 hours) for suspected pulmonary thromboembolism. The patient was successfully managed with red blood cell and plasma transfusions, multiple thoracenteses for evacuation of blood from the pleural space, short-term mechanical ventilation, and administration of bronchodilators, corticosteroids, and antibiotics. This is the first report of spontaneous hemothorax and the third report of spontaneous retroperitoneal hematoma associated with enoxaparin therapy.     

Effectiveness and safety of small-bore tube thoracostomy (≤20 Fr) for chest trauma patients: A retrospective observational study

IntroductionTube thoracostomy is an important treatment for traumatic hemothorax and pneumothorax. The optimal tube diameter remains unclear. To reduce invasiveness, we use small-bore chest tubes (≤20 Fr) for all trauma patients for whom tube thoracostomy is indicated in our emergency department (ED). The aim of this study was to investigate the effectiveness and safety of small-bore tube thoracostomy for traumatic hemothorax or pneumothorax.MethodWe conducted a retrospective observational study at a single emergency medical center. This study included adult patients (≥18 years old) who had undergone tube thoracostomy for chest trauma in the ED during the 5 years from October 2013 to September 2018. We used 20 Fr chest tubes or 8 Fr pigtail catheters. The examined outcome was tube-related complications, such as tube obstruction, retained hemothorax, and unresolved pneumothorax.ResultsA total of 107 tube thoracostomies were performed in 102 patients. The mean Injury Severity Score of these patients was 17.8 (±9.6), and the mean duration of the tube placement period was 3.9 days (±1.8). Eight patients developed tube-related complications (7.8%) (retained hemothorax: 4 patients (3.9%), unresolved pneumothorax: 4 patients (3.9%)). None of these cases were caused by tube obstruction. Although the drainage itself was effective, they underwent definitive invasive interventions to stop bleeding or air leak.ConclusionOur study showed that the use of small-bore (≤20 Fr) chest tubes to treat traumatic hemothorax/pneumothorax achieved the purposes of tube thoracostomy. It might be possible to safely manage chest trauma with small-bore chest tubes.     

Emergency department ultrasound for hemothorax after blunt traumatic injury

Diagnosing hemothorax after blunt trauma may be aided by emergency department (ED) ultrasound (US). Various prior studies have evaluated ED US using different gold standards. A prospective study of blunt trauma patients who underwent computed tomography (CT) scan of the chest, abdomen, or both, was performed. Before CT scan, an US examination was performed specifically to identify free fluid in the thorax. The CT scan findings were used as the gold standard for validation of US results. From July 1998 to June 1999, 142 of 155 patients who underwent US and CT scan for evaluation of blunt trauma were included in this study. The CT scan identified 16 cases of hemothorax among these patients. ED US resulted in 2 true-positive, 2 false-positive, 14 false-negative, and 124 true-negative findings. ED US was 12.5% sensitive and 98.4% specific. ED US did not detect small-volume hemothorax identified by CT scan. Future research should focus on further defining the size of hemothorax appreciable with ED US, with increased attention paid to the type of gold standard implemented for its evaluation.     

Surgical excision of umbilical endometriotic lesions with laparoscopic pelvic observation is the way to treat umbilical endometriosis

Primary umbilical endometriosis is extremely rare, although cases secondary to previous surgery have occasionally been reported. Here, we report three cases of umbilical endometriosis: two cases with previous cesarean section and one case of primary umbilical endometriosis. The treatment of choice for umbilical endometriosis is the excision of the lesions, and we believe laparoscopic pelvic observation is a beneficial addition, as 13%–15% of umbilical endometriosis cases are accompanied by pelvic endometriosis.     

子宫内膜异位症组织中促血管生成素-2的表达及其意义

目的：探讨促血管生成素2在子宫内膜异位症患者异位和在位子宫内膜组织中的表达，及其在子宫内膜异位症发病中的作用。方法：采用免疫组织化学方法检测30例子宫内膜异位症患者的异位内膜和在位内膜组织及30例正常对照组内膜组织中促血管生成素-2的表达。结果：在位内膜组织中促血管生成素-2的表达高于对照组和异位内膜组，差异有统计学意义（P〈0．05），异位内膜组高于对照组，差异亦有统计学意义（P〈0．05）。在位内膜组和对照组的不同月经周期促血管生成素2的表达差异有统计学意义（p〈0．05）。结论：促血管生成素-2在子宫内膜异位症组织中的高表达可能与子宫内膜异位症的发生、发展及血管生成密切相关。