Pulsatile bleeding after sternal bone marrow puncture
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IMAGING IN INTENSIVE CARE MEDICINE
Pulsatile bleeding after sternal bone marrow puncture M. Kindermans1, S. Abid1, S. Alkhoder2 and L. Bouadma1,3* © 2018 Springer-Verlag GmbH Germany, part of Springer Nature and ESICM
A 66-year-old man suffering from autoimmune myositis underwent a sternal bone marrow puncture. The procedure was performed by an experienced hematologist. Pulsatile bleeding occurred immediately after the internal needle was removed. The needle was immediately replaced (Fig. 1). A contrast-enhanced thoracic computed tomography (CT) scan with 3D reconstruction was performed. The CT scan revealed that the needle was penetrating the ascending aorta, through venomous trunk (Figs. 2, 3). The median distance between the skin surface and the aorta is typically 23.6 and 21.3 mm in men and women, respectively. It was around 32.8 mm
*Correspondence: [email protected] 1 Medical and Infectious Diseases ICU, Bichat‑Claude‑Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France Full author information is available at the end of the article
for our patient, while the length of our needle was 30 mm (Fig. 4). Life-threatening complications following sternal bone marrow puncture are exceeding rare. Few cases have been described involving lung or heart puncture. Risk factors for such complications are physician inexperience, incorrect location of puncture, sternal lytic areas, and incorrect needle length. Those life-threatening complications required immediate high-performance CT scan before urgent surgical management. The patient had a mini-sternotomy to remove the trocar and repair the aorta.
Figs. 1–4 1 Bone marrow needle and trocar in place just before thoracic CT scan. 2 Contrast-enhanced sagittal thoracic CT scan in the arterial phase showing the trocar through the sternum. 3 Coronal thoracic CT scan with 3D reconstruction. 4 Contrast-enhanced scan in the arterial phase showing distance between the skin surface and the aorta
Author details 1 Medical and Infectious Diseases ICU, Bichat‑Claude‑Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 2 Department of Cardiothoracic Surgery, Bichat‑Claude‑Bernard Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France. 3 UMR 1137, IAME Team5-DeScID: Decision Science
in Infectious Diseases, Control and Care, INSERM/Uniiversité Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France. Received: 19 April 2018 Accepted: 7 May 2018
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