Foo Chuan T, Herre Jurgen
Cambridge University Hospitals NHS Foundation Trust, Department of Respiratory Medicine, Cambridge, UK.
Case Rep Pulmonol. 2021 Jun 21;2021:5592086. doi: 10.1155/2021/5592086. eCollection 2021.
Retained haemothorax is a common sequela of traumatic haemothorax and refers to blood that cannot be drained from the pleural cavity. We report a case of trapped lung secondary to retained haemothorax in a patient who sustained a penetrating chest injury. Initial chest computed tomography (CT) showed a large haemothorax that was managed with an intercostal drain insertion (ICD). Repeat chest CT and thoracic ultrasonography performed after ICD removal showed an organized pleural space resembling haematoma. ICD was reinserted with administration of intrapleural fibrinolytic therapy (IPFT). Subsequent chest CT showed the development of a pleural rind and trapped lung. A second ICD was inserted, and further IPFT were administered together with aggressive negative pressure suction. Haemoglobin remained stable. The patient made a full recovery and imaging performed two weeks later showed minor blunting of the costophrenic angle. This case highlights the feasibility and safety of IPFT in the management of trapped lung associated with traumatic retained haemothorax as an alternative to surgery.
血胸残留是创伤性血胸的常见后遗症，指无法从胸腔引流的血液。我们报告一例因穿透性胸部损伤导致血胸残留继发肺陷闭的病例。最初的胸部计算机断层扫描（CT）显示大量血胸，通过插入肋间引流管（ICD）进行处理。在拔除ICD后进行的重复胸部CT和胸部超声检查显示胸膜腔有类似血肿的机化表现。重新插入ICD并给予胸膜腔内纤维蛋白溶解疗法（IPFT）。随后的胸部CT显示胸膜增厚和肺陷闭。插入了第二个ICD，并在积极负压吸引的同时进一步给予IPFT。血红蛋白保持稳定。患者完全康复，两周后进行的影像学检查显示肋膈角轻度变钝。该病例突出了IPFT作为手术替代方法在治疗与创伤性血胸残留相关的肺陷闭方面的可行性和安全性。
