Jahir Tahmina, Hossain Sadaf, Dolkar Tsering, Patel Meet J, Risal Ruby, Khan Ahmad, Kumari Aneeta, Schmidt Marie, Enriquez Danilo, Patel Harish
Pulmonary and Critical Care Medicine, One Brooklyn Health System-Interfaith Medical Center, New York, USA.
Internal Medicine, Jamaica Hospital Medical Center, New York, USA.
Cureus. 2022 Apr 24;14(4):e24450. doi: 10.7759/cureus.24450. eCollection 2022 Apr.
Etiologies of hemorrhagic pleural effusions (hemithoraces) are multifactorial. They can be traumatic, non-traumatic, or idiopathic in nature. In this report, we present a rare case of a 64-year-old male with end-stage renal disease (ESRD) on chronic hemodialysis and dual antiplatelet therapy (DAPT), due to a recent history of coronary arterial stent placement, who presented with progressive shortness of breath for one month. The CT of the chest revealed bilateral large pleural effusions (left > right) with a complete collapse of the left lung and partial collapse of the right lung. Ultrasound-guided left-sided thoracentesis revealed hemorrhagic pleural effusions. After the discontinuation of DAPT, drainage from the right-sided pleural effusion via a pigtail catheter showed continued drainage of pleural fluid without hemorrhage. The effusion on the left side was also noted to have resolved on the repeat chest X-ray. Prompt recognition of this rare cause of any hemorrhagic pleural effusion is essential for patients on dialysis to avoid complications. This report focuses on the possible etiology and potential complications of a hemorrhagic pleural effusion, followed by a brief discussion on the rare but significant association involving the incidence of a hemorrhagic pleural effusion in a dialysis patient receiving DAPT.
血性胸腔积液（半侧胸腔）的病因是多因素的。其本质上可以是创伤性、非创伤性或特发性的。在本报告中，我们呈现了一例罕见病例，一名64岁男性，患有终末期肾病（ESRD），正在接受慢性血液透析且因近期有冠状动脉支架置入史而接受双联抗血小板治疗（DAPT），他出现进行性气短1个月。胸部CT显示双侧大量胸腔积液（左侧>右侧），左肺完全萎陷，右肺部分萎陷。超声引导下左侧胸腔穿刺抽出血性胸腔积液。停用DAPT后，经猪尾导管对右侧胸腔积液进行引流，结果显示胸腔积液持续引流且无出血。复查胸部X线片时发现左侧积液也已消退。对于透析患者而言，迅速识别这种导致血性胸腔积液的罕见病因对于避免并发症至关重要。本报告重点关注血性胸腔积液的可能病因和潜在并发症，随后简要讨论接受DAPT的透析患者中血性胸腔积液发生率这一罕见但重要的关联。
