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Spontaneous Hemothorax in a Patient With von Recklinghausen's Disease.

Rodriguez-Guzman M, Gallegos-Carrera B, Vicente-Antunes S, Fernandez-Ormaechea I, Zapatero-Gaviria J, Villar-Alvarez F - J Clin Med Res (2014)

Bottom Line: An arteriography was performed, which showed the presence of bleeding from a branch of the right subclavian artery, which was selectively catheterized and embolized with coils.The patient had a good clinical and radiologic progression and was discharged after few days.After a year of follow-up, the patient has remained clinically asymptomatic with no further episodes of active bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Pneumology, IIS-Fundacion Jimenez Diaz, CIBERES, Madrid, Spain.

ABSTRACT
Type I neurofibromatosis (NF-1) is a rare autosomal dominant disease. It can affect any organ system including vascular tissues. A 53 years old man, with a past medical history of NF-1, retinitis pigmentosa and hypertension attended to the emergency department for chest pain and palpitations and was discharged 2 days after acute coronary syndrome was ruled out. During this admission an echocardiogram was performed which showed a left ventricular hypertrophy with normal ejection fraction and a chest X-ray which revealed no pathologic images. No invasive procedures were preformed. Three days after discharge, he returned to our hospital for sudden onset of oppressive chest pain in the right arm, irradiated to the ipsilateral shoulder, chest and back. After several tests, a diagnosis of hemothorax was made. Hemoglobin levels declined during the first 2 days of admission from 12.1 to 9.6 g/dL, although the patient remained hemodynamic stable. An arteriography was performed, which showed the presence of bleeding from a branch of the right subclavian artery, which was selectively catheterized and embolized with coils. Afterwards, a video-assisted thoracoscopy was made, in order to drain the hemothorax and to carry out a visual review of the pleural cavity. The patient had a good clinical and radiologic progression and was discharged after few days. After a year of follow-up, the patient has remained clinically asymptomatic with no further episodes of active bleeding.

No MeSH data available.


Related in: MedlinePlus

Chest radiograph in posteroanterior projection is shown in which a pleural effusion in the right lower field and a consolidation image at the top ipsilateral chest and adjacent to the mediastinum can be observed.
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Figure 1: Chest radiograph in posteroanterior projection is shown in which a pleural effusion in the right lower field and a consolidation image at the top ipsilateral chest and adjacent to the mediastinum can be observed.

Mentions: During his hospital stay, several diagnostic tests were performed. The admission blood analysis reported 14,600 leukocytes, 266,000 platelets and 4,900,000 erythrocytes with hemoglobin of 12.1 g/dL and hematocrit of 37.4%. The rest of the values of the blood count and biochemistry, including liver and kidney functions, were within normal limits. The posteroanterior and lateral chest radiographs showed pleural effusion in the lower right field and an image in the ipsilateral vertex adjacent to the mediastinum (Fig. 1). Given these findings, a cervicothoracic angio-CT (computed tomography) was performed, which showed moderate right pleural effusion with passive atelectasis. These findings and the level of hematocrit, measured in the effusion, were compatible with a diagnosis of hemothorax. In addition, a loculation in the right upper mediastinal was found, with active bleeding points from the cervical branch of the right subclavian artery (Fig. 2, 3).


Spontaneous Hemothorax in a Patient With von Recklinghausen's Disease.

Rodriguez-Guzman M, Gallegos-Carrera B, Vicente-Antunes S, Fernandez-Ormaechea I, Zapatero-Gaviria J, Villar-Alvarez F - J Clin Med Res (2014)

Chest radiograph in posteroanterior projection is shown in which a pleural effusion in the right lower field and a consolidation image at the top ipsilateral chest and adjacent to the mediastinum can be observed.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3935525&req=5

Figure 1: Chest radiograph in posteroanterior projection is shown in which a pleural effusion in the right lower field and a consolidation image at the top ipsilateral chest and adjacent to the mediastinum can be observed.
Mentions: During his hospital stay, several diagnostic tests were performed. The admission blood analysis reported 14,600 leukocytes, 266,000 platelets and 4,900,000 erythrocytes with hemoglobin of 12.1 g/dL and hematocrit of 37.4%. The rest of the values of the blood count and biochemistry, including liver and kidney functions, were within normal limits. The posteroanterior and lateral chest radiographs showed pleural effusion in the lower right field and an image in the ipsilateral vertex adjacent to the mediastinum (Fig. 1). Given these findings, a cervicothoracic angio-CT (computed tomography) was performed, which showed moderate right pleural effusion with passive atelectasis. These findings and the level of hematocrit, measured in the effusion, were compatible with a diagnosis of hemothorax. In addition, a loculation in the right upper mediastinal was found, with active bleeding points from the cervical branch of the right subclavian artery (Fig. 2, 3).

Bottom Line: An arteriography was performed, which showed the presence of bleeding from a branch of the right subclavian artery, which was selectively catheterized and embolized with coils.The patient had a good clinical and radiologic progression and was discharged after few days.After a year of follow-up, the patient has remained clinically asymptomatic with no further episodes of active bleeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Pneumology, IIS-Fundacion Jimenez Diaz, CIBERES, Madrid, Spain.

ABSTRACT
Type I neurofibromatosis (NF-1) is a rare autosomal dominant disease. It can affect any organ system including vascular tissues. A 53 years old man, with a past medical history of NF-1, retinitis pigmentosa and hypertension attended to the emergency department for chest pain and palpitations and was discharged 2 days after acute coronary syndrome was ruled out. During this admission an echocardiogram was performed which showed a left ventricular hypertrophy with normal ejection fraction and a chest X-ray which revealed no pathologic images. No invasive procedures were preformed. Three days after discharge, he returned to our hospital for sudden onset of oppressive chest pain in the right arm, irradiated to the ipsilateral shoulder, chest and back. After several tests, a diagnosis of hemothorax was made. Hemoglobin levels declined during the first 2 days of admission from 12.1 to 9.6 g/dL, although the patient remained hemodynamic stable. An arteriography was performed, which showed the presence of bleeding from a branch of the right subclavian artery, which was selectively catheterized and embolized with coils. Afterwards, a video-assisted thoracoscopy was made, in order to drain the hemothorax and to carry out a visual review of the pleural cavity. The patient had a good clinical and radiologic progression and was discharged after few days. After a year of follow-up, the patient has remained clinically asymptomatic with no further episodes of active bleeding.

No MeSH data available.


Related in: MedlinePlus