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CT 引导下肺肿瘤活检后发生大量血胸：一种不常见但后果严重的并发症。

Massive hemothorax after computed tomography-guided lung tumor biopsy: An unusual but disastrous complication.

机构信息

Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan.

Department of Medicine, MacKay Medical College, Taipei, Taiwan.

出版信息

Thorac Cancer. 2018 Jul;9(7):892-896. doi: 10.1111/1759-7714.12769. Epub 2018 May 23.

DOI:10.1111/1759-7714.12769
PMID:29791072
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6026619/
Abstract

Intercostal artery injury during transthoracic puncture is rare but is accompanied by high rates of morbidity and mortality. We report a case with metachronous double primary esophageal cancers and development of multiple lung nodules. Tissue proof for the lung nodules is required to guide the following treatment protocol. Our patient died soon after computed tomography-guided lung tumor biopsy was performed, as a result of procedure-related massive and uncontrolled hemothorax. The cause is likely intercostal artery injury related to the transthoracic puncture. After review of our case and the wide variation in intercostal artery courses, we identify several considerations that should be included in procedural planning to further decrease the risk of intercostal artery injury during transthoracic puncture, including avoiding choosing target lesions at the posterior lung, keeping the puncture needle as close to the superior rib margin as possible, and checking the density of new pleural fluid. In addition, it is important to inform clinical doctors when the risk of periprocedural vascular injury is high.

摘要

经胸穿刺时肋间动脉损伤很少见，但伴有很高的发病率和死亡率。我们报告了一例同时患有异时性双原发性食管癌和多个肺结节的病例。需要组织学证据来指导后续的治疗方案。由于与经胸穿刺相关的大量且无法控制的血胸，我们的患者在进行 CT 引导下肺肿瘤活检后很快死亡。病因可能是肋间动脉损伤。在回顾我们的病例和肋间动脉走行的广泛变化后，我们确定了在经胸穿刺过程中进一步降低肋间动脉损伤风险时应考虑的几个因素，包括避免选择后肺部的靶病变、使穿刺针尽可能靠近上肋缘以及检查新胸腔积液的密度。此外，当围手术期血管损伤风险较高时，及时告知临床医生非常重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/c799ee345f04/TCA-9-892-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/8c52c64c1395/TCA-9-892-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/ad348e82e480/TCA-9-892-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/82801ca67142/TCA-9-892-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/c7491918511c/TCA-9-892-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/c799ee345f04/TCA-9-892-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/8c52c64c1395/TCA-9-892-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/ad348e82e480/TCA-9-892-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/82801ca67142/TCA-9-892-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/c7491918511c/TCA-9-892-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/56db/6026619/c799ee345f04/TCA-9-892-g002.jpg

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Course and variation of the intercostal artery by CT scan.
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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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