Luo Xiaoli, Shi Weibin, Zhang Xiaoqun, Yang Xiaoli, Wang Wei, Zeng Chunyu, Wang Hongyong
Department of Cardiovascular Medicine, Institute of Field Surgery, Daping Hospital of The Third Military Medical University, Chongqing 400042, P.R. China.
Exp Ther Med. 2018 Mar;15(3):2351-2355. doi: 10.3892/etm.2018.5685. Epub 2018 Jan 2.
An elderly male patient with coronary heart disease underwent coronary angiography, which revealed bilateral severe coronary artery stenosis. Four stents were implanted, and at 5 h post-surgery, typical hemorrhagic shock appeared. Echocardiography verified heavy bleeding in the right thoracic cavity. Emergency angiography excluded injury or perforation of the coronary artery, aorta, right subclavian artery and brachiocephalic artery. Considering the patient's history of chronic obstructive pulmonary disease and severe cough during the operation, it was suspected that hemothorax was induced by a blood vessel rupture in the pleura. Video-assisted thoracic examination confirmed the tearing of pleural adhesion bands and bleeding at three sites in the pulmonary pleura and parietal pleura. According to the reported case, bleeding as a result of the laceration of pleural adhesions is an important cause of hemothorax that should be considered after exclusion of other common causes of pleural hemorrhage.
一名患有冠心病的老年男性患者接受了冠状动脉造影，结果显示双侧冠状动脉严重狭窄。植入了4个支架，术后5小时出现典型的失血性休克。超声心动图证实右侧胸腔大量出血。急诊血管造影排除了冠状动脉、主动脉、右锁骨下动脉和头臂动脉的损伤或穿孔。考虑到患者有慢性阻塞性肺疾病史且术中咳嗽剧烈，怀疑胸腔积血是由胸膜血管破裂所致。电视辅助胸腔检查证实胸膜粘连带撕裂，脏层胸膜和壁层胸膜有三处出血。根据报道的病例，胸膜粘连撕裂导致的出血是胸腔积血的一个重要原因，在排除其他常见的胸膜出血原因后应予以考虑。
