Harada T, Kato S, Kondo K, Teramoto T, Nagata Y
Department of Surgery, Aichi Medical University, Aichi, Japan.
Kyobu Geka. 2003 Dec;56(13):1085-9.
A case of pleuro-pneumonectomy following arterial embolization for chronic hemorrhagic pyothorax occurring 40 years after artificial pneumothorax treatment was investigated. The patient was an 80-year-old male diagnosed with chronic hemorrhagic pyothorax after complaining of bloody sputum and difficulty breathing during exertion. The pyothorax space was conspicuously extended, and the mediastinal space was compressed. Although this condition was treated periodically over time by thoracentesis, pleuro-pneumonectomy was selected as a radical treatment. Since a large amount of hemorrhaging was expected during surgery, preoperative transcatheter embolization of the left lateral thoracic artery, the bronchial arteries and the left internal thoracic artery was performed. The amount of hemorrhaging during surgery from the feeding artery from the thoracic wall was 5,700 ml. There was an abundance of dilated blood vessels within the thickened pleura, and angiomatous structures were observed. Although symptoms improved following surgery, sudden massive hemorrhage was observed from the thoracic drain on the morning of the 79th postoperative day, and the patient died from hemorrhagic shock. Emergency thoracotomy was performed, and aortic rupture was observed on the origin of the left subclavian artery. Chronic hemorrhagic pyothorax has a peculiar pathology even for chronic pyothorax, and a large amount of hemorrhaging can be expected during surgery. Precaution must be taken for postoperative arterial hemorrhage caused by delayed inflammation.
