PDF(Pubmed)
Abstract：
BACKGROUND: The occurrence of pulmonary visceral subpleural hematoma during care of post-cardiopulmonary resuscitation including chest compressions and anticoagulant and antiplatelet therapies is extremely rare. Also, there are few reports of treatment of visceral subpleural hematoma, most of which are treated by lung resection. Here we describe a rare case that pulmonary visceral subpleural hematoma arose during post-cardiopulmonary resuscitation care and was treated by hematoma evacuation.
METHODS: A 58-year-old male with no smoking history and, past medical histories of rheumatoid arthritis, chronic atrial fibrillation, hypertension, diabetes, and dyslipidemia developed ventricular fibrillation due to myocardial infarction and fainted. He received bystander cardiopulmonary resuscitation and defibrillation by the ambulance crew and had return of spontaneous circulation. After transfer to our hospital, the patient underwent percutaneous catheter intervention and stenting with a diagnosis of myocardial infarction, followed by anticoagulant and antiplatelet therapies. On the 8th hospital day, chest radiography suggested right lower lobe pneumonia, and subsequent chest computed tomography revealed pulmonary hematoma in the visceral subpleural area from S6 to S10. Since no improvement was observed in hypoxemia, treatment was considered necessary. First, an attempt at computed tomography-guided drainage of hematoma was made, but insertion of the Pig-tail catheter was difficult due to hardness of the hematoma. Next, evacuation of hematoma was performed on the 13th hospital day. The hematoma was located in the visceral subpleural area and was removed by incising the pleura. TachoSil Tissue Sealing sheet and Polyglycoal acid sheet were applied to the sites of air leakage and oozing after hematoma evacuation. No re-bleeding or air leakage was observed after the treatment, and the patient was discharged on the 26th hospital day after an uneventful course.
CONCLUSIONS: Pulmonary visceral subpleural hematoma may occur during post-cardiopulmonary resuscitation care, including chest compressions and anticoagulant and antiplatelet therapies. In our case, CT-guided puncture and drainage was difficult and surgical treatment by incision of the visceral pleura and hematoma evacuation alone was done successfully.
METHODS: A 58-year-old male with no smoking history and, past medical histories of rheumatoid arthritis, chronic atrial fibrillation, hypertension, diabetes, and dyslipidemia developed ventricular fibrillation due to myocardial infarction and fainted. He received bystander cardiopulmonary resuscitation and defibrillation by the ambulance crew and had return of spontaneous circulation. After transfer to our hospital, the patient underwent percutaneous catheter intervention and stenting with a diagnosis of myocardial infarction, followed by anticoagulant and antiplatelet therapies. On the 8th hospital day, chest radiography suggested right lower lobe pneumonia, and subsequent chest computed tomography revealed pulmonary hematoma in the visceral subpleural area from S6 to S10. Since no improvement was observed in hypoxemia, treatment was considered necessary. First, an attempt at computed tomography-guided drainage of hematoma was made, but insertion of the Pig-tail catheter was difficult due to hardness of the hematoma. Next, evacuation of hematoma was performed on the 13th hospital day. The hematoma was located in the visceral subpleural area and was removed by incising the pleura. TachoSil Tissue Sealing sheet and Polyglycoal acid sheet were applied to the sites of air leakage and oozing after hematoma evacuation. No re-bleeding or air leakage was observed after the treatment, and the patient was discharged on the 26th hospital day after an uneventful course.
CONCLUSIONS: Pulmonary visceral subpleural hematoma may occur during post-cardiopulmonary resuscitation care, including chest compressions and anticoagulant and antiplatelet therapies. In our case, CT-guided puncture and drainage was difficult and surgical treatment by incision of the visceral pleura and hematoma evacuation alone was done successfully.
摘要：
背景：在心肺复苏后包括胸部按压以及抗凝和抗血小板治疗期间，肺内脏胸膜下血肿的发生极为罕见。此外，治疗内脏胸膜下血肿的报道很少，其中大多数是通过肺切除术治疗的。在这里，我们描述了一种罕见的病例，即在心肺复苏后护理过程中出现了肺内脏胸膜下血肿，并通过血肿清除术进行了治疗。
方法：58岁男性，无吸烟史，过去的类风湿关节炎病史，慢性心房颤动,高血压,糖尿病,血脂异常因心肌梗死而发生室颤并晕倒。他接受了救护人员的旁观者心肺复苏和除颤，并恢复了自发循环。转移到我们医院后，患者接受经皮导管介入和支架置入术，诊断为心肌梗死，其次是抗凝和抗血小板治疗。在第8个住院日，胸片提示右下叶肺炎,随后的胸部计算机断层扫描显示，从S6到S10，内脏胸膜下区域有肺血肿。由于低氧血症没有改善，治疗被认为是必要的。首先,尝试在CT引导下进行血肿引流，但是由于血肿的硬度，很难插入猪尾导管。接下来,血肿清除术在第13天住院.血肿位于内脏胸膜下区域，并通过切开胸膜去除。将TachoSil组织密封片和聚乙醇酸片应用于血肿清除后的漏气和渗出部位。治疗后未再出血或漏气,患者在第26号医院经过平静的疗程后出院。
结论：心肺复苏后护理过程中可能出现肺内脏胸膜下血肿，包括胸部按压和抗凝和抗血小板治疗。在我们的案例中,CT引导下穿刺引流困难，仅通过内脏胸膜切开和血肿清除术成功进行了手术治疗。
方法：58岁男性，无吸烟史，过去的类风湿关节炎病史，慢性心房颤动,高血压,糖尿病,血脂异常因心肌梗死而发生室颤并晕倒。他接受了救护人员的旁观者心肺复苏和除颤，并恢复了自发循环。转移到我们医院后，患者接受经皮导管介入和支架置入术，诊断为心肌梗死，其次是抗凝和抗血小板治疗。在第8个住院日，胸片提示右下叶肺炎,随后的胸部计算机断层扫描显示，从S6到S10，内脏胸膜下区域有肺血肿。由于低氧血症没有改善，治疗被认为是必要的。首先,尝试在CT引导下进行血肿引流，但是由于血肿的硬度，很难插入猪尾导管。接下来,血肿清除术在第13天住院.血肿位于内脏胸膜下区域，并通过切开胸膜去除。将TachoSil组织密封片和聚乙醇酸片应用于血肿清除后的漏气和渗出部位。治疗后未再出血或漏气,患者在第26号医院经过平静的疗程后出院。
结论：心肺复苏后护理过程中可能出现肺内脏胸膜下血肿，包括胸部按压和抗凝和抗血小板治疗。在我们的案例中,CT引导下穿刺引流困难，仅通过内脏胸膜切开和血肿清除术成功进行了手术治疗。
