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肋间动脉撕裂：胸腔穿刺术的罕见并发症及超声在早期检测中的作用

Intercostal Artery Laceration: Rare Complication of Thoracentesis and Role of Ultrasound in Early Detection.

作者信息

Mansour Wissam, Samaha Ghassan, El Bitar Sandy, Esper Ziad, Maroun Rabih

机构信息

Department of Internal Medicine, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.

Department of Pulmonology and Critical Care Medicine, Northwell Health Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY 10305, USA.

出版信息

Case Rep Pulmonol. 2017;2017:6491083. doi: 10.1155/2017/6491083. Epub 2017 Aug 2.

DOI:10.1155/2017/6491083
PMID:28831322
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5558638/
Abstract

Hemothorax is a rare but potentially fatal postthoracentesis complication. Early clinical signs may be nonspecific resulting in diagnostic delay. A high index of suspicion is vital for early diagnosis and intervention to avoid further bleeding. Following procedure, early bedside ultrasound findings can be vital for early detection. We report a case of massive hemothorax in a 63-year-old male following therapeutic thoracentesis. Diagnosis was made following highly suggestive sonographic findings prompting thoracotomy and lacerated intercostal artery cauterization.

摘要

血胸是一种罕见但可能致命的胸腔穿刺术后并发症。早期临床症状可能不具特异性，导致诊断延迟。高度的怀疑指数对于早期诊断和干预以避免进一步出血至关重要。术后，早期床边超声检查结果对于早期发现至关重要。我们报告一例63岁男性在治疗性胸腔穿刺术后发生大量血胸的病例。在超声检查结果高度提示后进行了诊断，随后进行了开胸手术并对肋间动脉撕裂处进行了烧灼止血。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/95bb07604b29/CRIPU2017-6491083.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/600db5d5246b/CRIPU2017-6491083.001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/0cb637ed1a8e/CRIPU2017-6491083.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/95bb07604b29/CRIPU2017-6491083.005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/600db5d5246b/CRIPU2017-6491083.001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/27d862fa2363/CRIPU2017-6491083.002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/b7f1176b268d/CRIPU2017-6491083.003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/0cb637ed1a8e/CRIPU2017-6491083.004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a9bb/5558638/95bb07604b29/CRIPU2017-6491083.005.jpg

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本文引用的文献

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Complications of thoracentesis: incidence, risk factors, and strategies for prevention.胸腔穿刺术的并发症：发生率、危险因素及预防策略。
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Ultrasound in the diagnosis and management of pleural effusions.超声在胸腔积液诊断与处理中的应用
实时检测猪模型血胸并监测其进展的电阻抗断层成像：一项可行性研究。
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Avoiding vessel laceration in thoracentesis: a role of vascular ultrasound with color Doppler.避免胸腔穿刺中的血管损伤：彩色多普勒血管超声的作用。
Chest. 2015 Jan;147(1):e5-e7. doi: 10.1378/chest.14-0814.
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Thoracentesis and the risks for bleeding: a new era.胸腔穿刺术与出血风险：新时代
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Physician-performed ultrasound can accurately screen for a vulnerable intercostal artery prior to chest drainage procedures.在进行胸部引流术之前，医生操作的超声检查可以准确地筛查出易损的肋间动脉。
Respirology. 2013 Aug;18(6):942-7. doi: 10.1111/resp.12088.
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Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions.经皮影像引导介入治疗中凝血状态和止血风险围手术期管理的共识指南。
J Vasc Interv Radiol. 2012 Jun;23(6):727-36. doi: 10.1016/j.jvir.2012.02.012. Epub 2012 Apr 17.
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Demonstration of the course of the posterior intercostal artery on CT angiography: relevance to interventional radiology procedures in the chest.CT 血管造影中后肋间动脉走行的显示：与胸部介入放射学程序的相关性。
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