Gargano Giancarlo, Paltrinieri Anna Lucia, Gallo Claudio, Di Pancrazio Luciana, Roversi Maria Federica, Ferrari Fabrizio
Department of Obstetric and Pediatric, Neonatal Intensive Care Unit (NICU), Arcispedale S. Maria Nuova, Istituto Tecnologie Avanzate e Modelli Assistenziali in Oncologia-IRCCS, Viale Risorgimento n. 70, 42100, Reggio Emilia, Italy.
Department of Radiology, University Hospital, Modena, Italy.
Ital J Pediatr. 2015 Nov 14;41:88. doi: 10.1186/s13052-015-0196-5.
Thymic enlargement is a common and physiological finding in children and neonates' X-rays, but it is usually asymptomatic. Occasionally it can cause respiratory distress. In most cases the aetiology of this expansion remains unclear and it is diagnosed as a thymic hyperplasia. True thymic hyperplasia is defined as a gland expansion, both in size and weight, while maintaining normal microscopic architecture. Often it is a diagnosis of exclusion and prognosis is good. Thymic haemorrhage is an unusual condition related to high foetal and neonatal mortality.
We report a case of spontaneous massive thymic haemorrhage in a newborn developing at birth acute respiratory distress associated with severe bilateral haemothorax. Thymic enlargement was evident after pleural evacuation and confirmed by radiographic, Computed Tomography (CT) images and Magnetic Resonance Imaging (MRI) sequences. The spontaneous resolution of this enlargement seen with CT scan and MRI sequences suggested a thymic haemorrhage; surgery was not necessary.
Thymic haemorrhage should be considered in newborn infants with pleural effusion, mediastinal space enlargement and Respiratory Distress.
胸腺增大在儿童和新生儿的X线检查中是一种常见的生理性表现，但通常无症状。偶尔它会导致呼吸窘迫。在大多数情况下，这种增大的病因仍不清楚，被诊断为胸腺增生。真性胸腺增生定义为腺体在大小和重量上均增大，同时保持正常的微观结构。它通常是一种排除性诊断，预后良好。胸腺出血是一种不常见的情况，与胎儿和新生儿的高死亡率相关。
我们报告一例新生儿自发性大量胸腺出血病例，该新生儿出生时出现急性呼吸窘迫并伴有严重双侧血胸。胸腔引流后胸腺增大明显，经X线、计算机断层扫描（CT）图像和磁共振成像（MRI）序列证实。CT扫描和MRI序列显示这种增大自行消退，提示胸腺出血；无需手术。
对于有胸腔积液、纵隔增宽和呼吸窘迫的新生儿，应考虑胸腺出血。
