Kuo Y C, Wang H C, Chu K A, Lu J Y
Department of Internal Medicine, Veterans General Hospital-Kaohsiung, Taiwan, ROC.
Zhonghua Yi Xue Za Zhi (Taipei). 2000 Feb;63(2):170-4.
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.
自发性纵隔血肿在血液系统恶性肿瘤中很少见。我们报告一例慢性髓性白血病患者，最初表现为自发性血肿和血胸。除详细病史外，胸部计算机断层扫描对于分析前纵隔是否存在肿块病变很重要。磁共振成像有助于确诊纵隔血肿的性质。在诊断胸部自发性出血时，应首先排除外伤、血管疾病和凝血病。在我们的患者中，纵隔血肿在三个月后自行消退。在自发性纵隔血肿的鉴别诊断中应考虑白血病。对于患有自发性纵隔血肿的白血病患者，除非怀疑有大量出血或胸腔活动性出血，支持性观察和密切随访可能比手术更好。
