Gorter Erwin A, Dubois Emile F L, Guicherit Onno R, Urlings Thijs A J, de Mol van Otterloo J C Alexander
Medisch Centrum Haaglanden, Afd. Heelkunde, Den Haag, the Netherlands.
Ned Tijdschr Geneeskd. 2012;156(20):A4425.
Spontaneous haemopneumothorax is a rare disorder and is defined as spontaneous pneumothorax associated with the accumulation of more than 400 ml of blood in the pleural cavity.
A 32-year-old male presented at the emergency department following sudden onset of right-sided stinging chest pain and difficulty in breathing. The chest X-ray showed right-sided hydropneumothorax. A tube thoracostomy was performed, which immediately drained 1500 ml of sanguinolent fluid. The first CT-scan showed no active bleeding. Several hours later the patient became haemodynamically unstable and an additional CT-angiogram was performed. This revealed an extravasation in the area of the second posterior intercostal artery, which was successfully embolised subsequently. This resulted in a haemodynamically stable patient, allowing elective video-assisted thoracic surgery.
Spontaneous haemopneumothorax is a life-threatening disorder. After initial drainage video-assisted thoracic surgery is to be preferred to conservative treatment or thoracotomy. However, it is necessary for the patient to be haemodynamically stable. In this case intervention radiology contributed to a minimally invasive approach. This therefore also merits consideration as a therapeutic option.
自发性血气胸是一种罕见疾病，定义为与胸腔内积聚超过400毫升血液相关的自发性气胸。
一名32岁男性因突发右侧刺痛性胸痛和呼吸困难就诊于急诊科。胸部X线显示右侧液气胸。进行了胸腔闭式引流术，立即引出1500毫升血性液体。首次CT扫描未显示活动性出血。数小时后患者血流动力学不稳定，遂进行了额外的CT血管造影。结果显示第二后肋间动脉区域有造影剂外渗，随后成功进行了栓塞。这使患者血流动力学稳定，得以进行选择性电视辅助胸腔镜手术。
自发性血气胸是一种危及生命的疾病。在初始引流后，电视辅助胸腔镜手术优于保守治疗或开胸手术。然而，患者血流动力学必须稳定。在本病例中，介入放射学有助于采用微创方法。因此，这也值得作为一种治疗选择加以考虑。
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