Akiyama K, Takazawa A, Hirota J, Yamagishi H, Akazawa T
Department of Cardiovascular Surgery, Iwaki Kyoritsu General Hospital, Iwaki City, Fukushima, Japan.
J Cardiovasc Surg (Torino). 1998 Dec;39(6):869-71.
We present an unusual case of a ruptured descending thoracic aortic aneurysm into the right pleural cavity of a patient with pectus carinatum. The presence of pectus carinatum played an important role in the development of the aneurysm at the atypical site and the rupture into the right pleural cavity. A small amount of right pleural bleeding on admission can increase and develop to massive hemothorax until emergency operation. Massive bleeding in the right pleural cavity where the dependent lung is located causes atelectasis and increased shunt fraction under one lung ventilation. Therefore, continuous drainage of the right pleural cavity is essential to prevent serious hypoxia during graft replacement in a case of ruptured descending thoracic aneurysm into the right hemithorax.
我们报告了一例罕见病例，一名鸡胸患者降主动脉瘤破裂进入右侧胸腔。鸡胸的存在在非典型部位动脉瘤的发展以及破裂进入右侧胸腔过程中起到了重要作用。入院时少量的右侧胸腔出血可能会增加并发展为大量血胸，直至进行急诊手术。位于患侧肺所在的右侧胸腔大量出血会导致肺不张，并在单肺通气时增加分流分数。因此，对于降主动脉瘤破裂进入右半胸的病例，在进行移植置换时，持续引流右侧胸腔对于预防严重缺氧至关重要。
