522
522
复制标题
第522章
DOI：
10.1097/01.ccm.0000551274.41220.7f
复制
发表时间：
2019
影响因子：
8.8
通讯作者：
Prashant Purohit
中科院分区：
文献类型：
--
作者：
S. Johnson;H. Kinoshita;Briand C. Wu;W. Kyono;E. Fong;V. Reddy;Prashant Purohit
方法：一个以前健康的无发热的5周大的足月男性，因咳嗽、充血、苍白、呼吸窘迫和低氧血症到急诊室就诊。他表现出心动过速和毛细血管再充盈延迟。胸部X线检查显示左侧浸润和大量胸腔积液。他的血红蛋白（Hgb）为8，无白细胞增多或血小板减少; CRP为8.8。患者接受静脉注射（IV）抗生素并转入PICU。放置胸管，立即引流140 ml新鲜血液，无进一步血流动力学失代偿。胸腔液显示400 WBC和4g蛋白，恶性肿瘤细胞学阴性。他总共接受了3次20 ml/kg的液体推注。随访Hgb为5.6，因此给予PRBC输血。胸部CT显示左侧小气胸和胸腔积液伴双侧散在浸润与肺不张。急诊室的BNP为3280，第2天为344，第3天为107。患者在第2天接受了两次呋塞米治疗。在第3天移除胸管，随后无再蓄积。输血后Hgb为17.1，第9天出院时为15.5。患者接受3天维生素K和7天IV抗生素治疗。无出血或自身免疫性疾病的既往史或家族史。PT为14.7，其余凝血特征血管性血友病因子抗原、瑞斯托康辅助因子、因子XIII和血小板聚集均正常。超声心动图显示膜周室间隔缺损（0.4 x 0. 5cm），但BNP无临床心力衰竭的趋势使血胸的心源性可能性降低。CT血管造影未显示AVM，尽管受到多灶性肺不张的限制。呼吸道PCR对鼻/肠道病毒呈阳性，血液和胸水培养呈阴性。创伤检查包括骨骼检查、头部超声和眼部检查均为阴性。在一个月的随访中，患者有一个稳定的血红蛋白，没有复发性胸腔积液。结果：虽然病因仍然难以捉摸的心血管，血液学，感染，恶性和创伤的观点，这种情况下，增加了文献中罕见的病例。我们还提出了一种可能的方法，诊断工作的基础上，文献综述，因为没有这些情况下的指导方针。
Methods: A previously healthy afebrile 5-week-old term male presented with cough, congestion, pallor, respiratory distress and hypoxemia to the ER. He exhibited tachycardia and delayed capillary refill. A chest x-ray showed infiltrate and a large pleural effusion on the left. He had a hemoglobin (Hgb) of 8 without leukocytosis or thrombocytopenia; CRP was 8.8. He received intravenous (IV) antibiotics and was transferred to the PICU. A chest tube was placed with immediate drainage of 140ml of frank blood without further hemodynamic decompensation. Pleural fluid showed 400 WBCs and 4g protein with negative cytology for malignancy. He was given a total of three 20ml/kg fluid boluses. A follow up Hgb was 5.6, so he was given a PRBC transfusion. A chest CT revealed a small left pneumothorax and a pleural effusion with scattered bilateral infiltrates versus atelectasis. BNP was 3280 in the ER, 344 on day 2 and 107 on day 3. He did receive furosemide twice on day 2. The chest tube was removed on day 3 without subsequent re accumulation. Post transfusion Hgb was 17.1 and 15.5 upon discharge on day 9. The patient received 3 days of Vitamin K and 7 days of IV antibiotics. There was no past or family history of bleeding or autoimmune disorders. PT was 14.7, and the rest of his coagulation profile Von Willebrand factor antigen, ristocetin cofactor, factor XIII and platelet aggregation were normal. Echocardiogram showed a perimembranous VSD (0.4 x0. 5cm), but the trend of BNP without clinical heart failure made cardiac origin of hemothorax less likely. CT angiogram did not show AVM, although was limited by multifocal atelectasis. Respiratory PCR was positive for rhino/enterovirus with negative blood and pleural fluid cultures. Trauma work up including skeletal survey, head ultrasound and eye exam were negative. At one month follow up, the patient had a stable Hgb and no recurrent pleural effusion.Results: While the etiology remains elusive from cardiovascular, hematological, infectious, malignant and trauma standpoint, the case adds to the literature of rare cases. We also present a possible approach for the diagnostic work up based on literature review, since there are no guidelines for these cases.