Tension hemothorax 1 week after pericardiocentesis associated with thrombocytopenia
Tension hemothorax 1 week after pericardiocentesis associated with thrombocytopenia
复制标题
心包穿刺术后1周出现张力性血胸并伴有血小板减少
DOI：
10.1111/ped.15395
复制
发表时间：
2022
影响因子：
1.4
通讯作者：
Kato Taichi
中科院分区：
文献类型：
--
作者：
Yamamoto Hidenori;Go Kiyotaka;Morimoto Yoshihito;Fukasawa Yoshie;Kato Taichi
小儿心包积液最常与肿瘤相关(1)，在造血干细胞移植（HSCT）后，其发生率为10%(2)。虽然心包引流的每一种方法，即经皮引流和手术引流，在并发症发生率和重复放置率方面都有各自的优势(3)，但由于这些患者的免疫抑制状态，通常会选择经皮引流。传统上，经皮引流采用剑突下入路，但对于肝肿大的患者，通常采用经胸入路，两者的并发症发生率没有差异(4)。肋间动脉损伤引起的血胸是经皮经胸心包穿刺术的并发症，通常发生在穿刺时，随着时间的推移而发展。本文报告一例经胸心包穿刺后第8天突然出现紧张性血胸并伴有血小板减少症。这是首次报道迟发性紧张性血胸，以往未见类似报道。本文的发表征得了患者父母的同意。患者是一名6岁女孩，因慢性活动性爱泼斯坦-巴尔病毒感染接受了造血干细胞移植。移植后3周被证实，但由于血栓性微血管病变引起的心包积液，经类固醇和肝素治疗后，随着时间的推移而积累和增加（图1a）。下肢水肿和呼吸困难，即双侧心力衰竭症状，逐渐加重
Pediatric pericardial effusions are most often associated with neoplasms (1), with an incidence of> 10% after hematopoietic stem cell transplantation (HSCT)(2). Though each method of pericardial drainage, that is, percutaneous or surgical, has advantages in terms of complication rates or repetitive placement rates, respectively (3), the percutaneous method is often selected in these patients because of their immunosuppressed state. Percutaneous drainage has traditionally been performed with the subxiphoid approach, but in patients with hepatomegaly, it is often done with the transthoracic approach, and there is no difference in complication rates between the two (4). Hemothorax due to intercostal artery injury is a complication of percutaneous transthoracic pericardiocentesis, generally occurring at the moment of puncture and progressing over time. A case in which tension hemothorax developed suddenly on the 8th day after transthoracic pericardiocentesis associated with thrombocytopenia is reported. This is the first report of delayed tension hemothorax without similar reports in the past. Consent for submission of this article was obtained from the patient’s parents.The patient was a 6-year-old girl who underwent HSCT for chronic active Epstein-Barr virus infection. Engraftment was confirmed 3 weeks after HSCT, but a pericardial effusion due to thrombotic microangiopathy, which was treated with steroids and heparin, accumulated and increased over time (Fig. 1a). Lower limb edema and dyspnea, that is, bilateral heart failure symptoms, gradually