Magnone Stefano, Gotti Riccardo, Giulii Capponi Michela, Paderno Nadiane, Maraglino Cosimo, Cadei Manuela, Mario Consuelo, Lucianetti Alessandro
First General Surgery Unit, Bergamo, Italy.
Vascular Surgery Unit, Bergamo, Italy.
Int J Surg Case Rep. 2019;60:323-326. doi: 10.1016/j.ijscr.2019.06.024. Epub 2019 Jun 20.
Tension hemothorax is a rare event, due to different causes: trauma, ruptured thoracic aorta aneurysms, or as a complication of central venous line placement due to inadvertent artery puncture or cannulation. Tension hemothorax leads to both hypovolemic and obstructive shock and can require emergency management.
A 63 years old lady underwent a complicated surgical procedure for a postoperative small bowel obstruction after radical cystectomy. During the procedure, a central venous catheter was placed, under ultrasound guidance, in the right jugular vein but an unknown puncture of the right subclavian artery occurred. In the early phase of the postoperative course, a hypovolemic/obstructive shock developed because of a tension hemothorax. The patient underwent an emergency thoracotomy in the hybrid room, followed by an endovascular repair of the arterial laceration. A recurrent hemothorax developed a few hours later because of an endoleak that was treated successfully with a second endovascular approach and a balloon dilatation of the stent.
tension hemothorax due to inadvertent subclavian artery laceration can be life-threatening and should be managed in a hybrid room with endovascular and surgical capabilities.
张力性血胸是一种罕见情况，由不同原因引起：创伤、胸主动脉瘤破裂，或作为中心静脉置管的并发症，原因是意外动脉穿刺或插管。张力性血胸会导致低血容量性休克和梗阻性休克，可能需要紧急处理。
一名63岁女性在根治性膀胱切除术后因术后小肠梗阻接受了复杂的外科手术。手术过程中，在超声引导下于右颈内静脉放置了中心静脉导管，但右锁骨下动脉发生了不明穿刺。在术后早期，因张力性血胸出现了低血容量性/梗阻性休克。患者在杂交手术室接受了紧急开胸手术，随后对动脉撕裂进行了血管腔内修复。数小时后因内漏出现复发性血胸，通过第二次血管腔内治疗和支架球囊扩张成功处理。
因意外锁骨下动脉撕裂导致的张力性血胸可能危及生命，应在具备血管腔内治疗和手术能力的杂交手术室进行处理。
