Issaivanan Magimairajan, Baranwal Purnima, Abrol Sunil, Bajwa Gurjot, Baldauf Mary, Shukla Mayank
Division of Pediatric Pulmonary Medicine, Brookdale University Hospital Medical Center, One Brookdale Plaza, Brooklyn, NY 11212, USA.
Pediatrics. 2006 Oct;118(4):e1268-70. doi: 10.1542/peds.2006-0766. Epub 2006 Sep 18.
Spontaneous hemopneumothorax is rare, occurs in young adolescents, and can be life threatening secondary to massive bleeding. An adolescent with spontaneous hemopneumothorax and shock managed by tube thorascostomy is described here. We compared our case with published data of spontaneous hemopneumothorax in the pediatric age group. Spontaneous hemopneumothorax involves the accumulation of air and blood in the pleural space in the absence of trauma or other obvious causes. Spontaneous hemopneumothorax is usually seen in adolescents, more common in males than females. The common clinical features of spontaneous hemopneumothorax include dyspnoea and chest pain, and 30% present with hypovolemic shock. The bleeding can result from a torn adhesion between the parietal and visceral pleurae, from a rupture of vascularized bullae, or from torn congenital aberrant vessels. Over the last 6 decades, the treatment has progressed from the thoracotomy to minimally invasive techniques such as video assisted thoracoscopic surgery, with great reduction in mortality and recurrence rates. Although a rare entity, diagnosis of spontaneous hemopneumothorax must be considered in young adolescents presenting with spontaneous onset of chest pain and dyspnoea with radiograph findings of hydropneumothorax and/or signs of shock.
自发性血气胸较为罕见，多见于青少年，大量出血可危及生命。本文描述了一名因自发性血气胸并休克而接受胸腔闭式引流术治疗的青少年患者。我们将该病例与已发表的儿科年龄组自发性血气胸数据进行了比较。自发性血气胸是指在无创伤或其他明显原因的情况下，胸膜腔内积气和积血。自发性血气胸通常见于青少年，男性多于女性。自发性血气胸的常见临床特征包括呼吸困难和胸痛，30%的患者会出现低血容量性休克。出血可能源于壁层胸膜与脏层胸膜之间的粘连撕裂、血管化肺大疱破裂或先天性异常血管撕裂。在过去60年里，治疗方法已从开胸手术发展到电视辅助胸腔镜手术等微创技术，死亡率和复发率大幅降低。尽管自发性血气胸是一种罕见疾病，但对于出现胸痛和呼吸困难且胸部X线片显示液气胸和/或休克体征的青少年，必须考虑到自发性血气胸的诊断。
