Division of Interventional Radiology, Department of Medical Imaging, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou, China.
Vasc Endovascular Surg. 2021 Oct;55(7):761-765. doi: 10.1177/15385744211005656. Epub 2021 Mar 24.
We report a case of a 50-year-old man with a 10-year history of pedicle screw internal fixation in the thoracic spine and heroin abuse, who presented with sudden-onset massive hemoptysis with hemorrhagic shock and asphyxia. Urgent contrast-enhanced chest computed tomography (CT) characteristically showed thoracic aortic perforation, a paravertebral pseudoaneurysm, and an intrapulmonary hematoma. Emergency percutaneous thoracic endovascular aortic repair (pTEVAR) with the preclose technique using a vascular closure device under local anesthesia achieved success without any complications. The current case highlights the importance of understanding massive hemoptysis caused by an aortobronchial fistula related to pedicle screw impingement in clinical practice and the value of pTEVAR with the preclose technique under local anesthesia in the emergency setting.
我们报告了一例 50 岁男性患者，10 年前胸椎行椎弓根螺钉内固定术，有海洛因滥用史，突发大咯血伴失血性休克和窒息。紧急增强胸部 CT 特征性显示胸主动脉穿孔、椎旁假性动脉瘤和肺内血肿。在局部麻醉下使用血管闭合装置的预闭合技术进行紧急经皮胸主动脉腔内修复术（pTEVAR）取得成功，无任何并发症。本病例强调了在临床实践中理解由椎弓根螺钉撞击引起的主支气管瘘导致大咯血的重要性，以及在紧急情况下局部麻醉下使用预闭合技术进行 pTEVAR 的价值。
