Spontaneous bilateral extrapleural hematoma: a case report
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CASE REPORT
Open Access
Spontaneous bilateral extrapleural hematoma: a case report Sheng-I Hu1, Shih-Chun Lee2, Hung Chang2 and Yen-Shou Kuo2*
Abstract Extrapleural hematoma (EPH) is a rare condition characterized by the accumulation of blood in the extrapleural space. EPH is generally identified by computed tomography (CT), which shows an inward displacement of extrapleural fat due to intrathoracic peripheral fluid accumulation (Ann Ital Chir 75(83): 5, 2004; J Korean Radiol Soc 49: 89–97, 2003; Monaldi Arch Chest Dis 63(3): 166–169, 2005). EPH has been reported to be associated with chest trauma and injuries. However, the correlation between hemodialysis and EPH has not yet been reported. The causes of EPH in a hemodialysis patient have been postulated, which include high venous flow through the arteriovenous fistula that results in an increase in venous pressure stenosis and/or thrombosis of the brachiocephalic and/or subclavian veins. These conditions thereby induce an increase in venous pressure in the intercostals and bronchial veins of the chest. Pleural fluid resorption is rare and excess pleural fluid formation commonly occurs (J Thoracic Imaging 26(3): 218–223, 2011). The occurrence of pleuritis with fusion of the two pleuric layers results in hematoma development in the extrapleural space instead of the pleural space. We present a chronic hemodialysis patient with spontaneous unilateral EPH. The progression to bilateral EPH was noted after VATS procedure. Awareness of EPH and the use of conservative management are key points for the treatment of this rare clinical condition. Keywords: Extrapleural hematoma, hemodialysis, AV fistula
Background Spontaneous extrapleural hematoma (EPH) is a rare disorder. We present a case of a chronic hemodialysis patient with spontaneous EPH. Surgical intervention was performed but was unsucessful, and the patient eventually died. In this report, we review the literature on spontaneous EPH as well as discuss the etiology and possible solutions for this condition. Case presentation A 66-year-old male was admitted to our facility with a chief complaint of low-grade fever (body temperature: 37.8 °C) and progressive exertional dyspnea for past 3 days. The patient underwent regular hemodialysis for 10 years as treatment for diabetic nephropathy. He had a history of valvular heart disease with severe mitral regurgitation with congestive heart failure and underwent mitral valve repair 2 years prior to consultation. Regular * Correspondence: [email protected] 2 Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, 325, Cheng-Kung Road 2nd Section, Taipei 114, Taiwan Full list of author information is available at the end of the article
outpatient department follow-up with oral ticlopidine at a dose of 100 mg daily was recorded. Neither recent medical history with surgical procedure nor recent trauma history was reported. The patient went to our emergency department and his chest plain film revealed unilateral (right side) fat-shape
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