Muraoka M, Nakamura A, Eguchi M, Hisamatsu I, Toriyama K
Department of Surgery, Zeshinkai Hospital Nagasaki, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1997 Jul;45(7):1028-33.
Spontaneous hemopneumothorax is a rare disease and intrathoracic bleeding reportedly occurs in the detached region of adhesive parietal pleura, aberrant vessel and cystic wall. We experienced two cases of bleeding most likely from the aberrant vessel. One patient was a 25-year-old male who had severe chest pain with dyspnea for four days. Chest X-ray revealed left pneumothorax and mediastinal shift to the right. Approximately 1500 ml of blood was aspirated from the left thoracic cavity. Since bleeding continued, emergency thoracotomy was performed. A restiform structure was noted in the bulla at the apex of the lung and the stump of the structure was considered as the source of bleeding. The other patient was a 29-year-old male who underwent emergency operation 16 hours after the massive bleeding amounting to 1800 ml. At the thoracotomy, a ruptured bulla at the apex of the collapsed lung with restiform structure was encountered. The bleeding point in the stump of the structure was ligated and the ruptured bulla was resected. In the histological study of these patients, an aberrant blood vessel was revealed in the restiform structure, which suggests the etiology of the bleeding. Their postoperative course was uneventful and had no symptom at the discharge. In the management of spontaneous hemopneumothorax, early thoracotomy should be the first consideration taking into account the massive bleeding from the aberrant vessel as in the cases.
自发性血气胸是一种罕见疾病，据报道胸腔内出血发生在粘连性壁层胸膜的分离区域、异常血管和囊肿壁。我们遇到了两例很可能来自异常血管的出血病例。一名患者是25岁男性，因严重胸痛伴呼吸困难4天入院。胸部X线显示左侧气胸，纵隔向右移位。从左侧胸腔抽出约1500毫升血液。由于出血持续，遂行急诊开胸手术。在肺尖部的肺大疱中发现一个索状结构，该结构的残端被认为是出血源。另一例患者是29岁男性，在大量出血达1800毫升后16小时接受了急诊手术。开胸手术时，在萎陷肺尖部发现一个破裂的带有索状结构的肺大疱。结扎该结构残端的出血点并切除破裂的肺大疱。在对这些患者的组织学研究中，在索状结构中发现了一条异常血管，这提示了出血的病因。他们术后恢复顺利，出院时无症状。在自发性血气胸的治疗中，考虑到如本例中来自异常血管的大量出血，早期开胸手术应作为首要考虑。
