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Embolization of Intercostal Arteries in Iatrogenic Haemothorax
Embolización de arterias intercostales en un hemotórax iatrogénico
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class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Cervical and Mediastinal Hematoma Caused by a Carotid Injury After Jugular Vein Cannulation, Treated by Stent" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "342" "paginaFinal" => "344" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hematoma cervical y mediastínico por herida carotídea al canalizar la vena yugular resuelta mediante stent" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 433 "Ancho" => 1951 "Tamanyo" => 130280 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">CT scan: (A) hematoma in the region of C6 with compression of the trachea; (B) hematoma at the T3 level, with the trachea below the orotracheal tube showing reduced diameter due to compression; C) slice at T1 where a decrease in the hematoma can be observed on the 4th day post-op.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Erik Llàcer-Millán, Pablo Ramírez, José Sanmartín, Joaquín Zamarro, Pascual Parrilla" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Erik" "apellidos" => "Llàcer-Millán" ] 1 => array:2 [ "nombre" => "Pablo" "apellidos" => "Ramírez" ] 2 => array:2 [ "nombre" => "José" "apellidos" => "Sanmartín" ] 3 => array:2 [ "nombre" => "Joaquín" "apellidos" => "Zamarro" ] 4 => array:2 [ "nombre" => "Pascual" "apellidos" => "Parrilla" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0009739X14000505" "doi" => "10.1016/j.ciresp.2013.12.015" "estado" => "S300" "subdocumento" => "" "abierto" => 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true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Embolization of Intercostal Arteries in Iatrogenic Haemothorax" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "340" "paginaFinal" => "341" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José Jacob Motos-Micó, Teresa Alves-Conciecao, Lorena López-Martínez, Orlando Fuentes-Porcel, Rafael Rosado-Cobián" "autores" => array:5 [ 0 => array:4 [ "nombre" => "José Jacob" "apellidos" => "Motos-Micó" "email" => array:1 [ 0 => "jacob_motos@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Teresa" "apellidos" => "Alves-Conciecao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Lorena" "apellidos" => "López-Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Orlando" "apellidos" => "Fuentes-Porcel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Rafael" "apellidos" => "Rosado-Cobián" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía General y Aparato Digestivo, Hospital Torrecárdenas, Almería, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiología Intervencionista, Hospital Torrecárdenas, Almería, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Embolización de arterias intercostales en un hemotórax iatrogénico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 882 "Ancho" => 995 "Tamanyo" => 144487 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior chest radiograph: large right hydropneumothorax with moderate lung collapse and air-fluid level that reaches the right mid-lung.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Iatrogenic hemothorax is a rare complication after chest tube insertion. It is mainly caused by injury to the intercostal blood vessels. Treatment involves pleural drainage, and thoracotomy is usually required for hemostasis.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> Occasionally, embolization of the intercostal arteries is an effective therapeutic alternative.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 21-year-old male patient who smoked one packet of cigarettes per day. He came to our Emergency Department due to sharp, sudden chest pain on the right side, accompanied by dyspnea. Upon examination, the patient was conscious, focused and hemodynamically stable. Lung auscultation detected diminished vesicular breath sounds in the base of the right lung, with no evidence of jugular ingurgitation. Anteroposterior chest radiography showed important right hydropneumothorax with moderate lung collapse and an air-fluid level that reached the middle of the right lung field (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>). A 20 Fr chest drain tube was inserted in the right hemithorax in the region of the 5th intercostal space on the anterior axillary line with drainage of air and less than 100<span class="elsevierStyleHsp" style=""></span>ml of non-hemorrhagic serous liquid. Proper placement of the tube was confirmed radiologically, and the right lung was observed to re-expand adequately.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">After 24<span class="elsevierStyleHsp" style=""></span>h, the patient's general condition worsened, with no vesicular breath sounds in the right hemithorax, blood pressure 90/60, and drainage of more than 800<span class="elsevierStyleHsp" style=""></span>ml of bloody fluid at more than 400<span class="elsevierStyleHsp" style=""></span>ml per hour. Chest CT scan with intravenous contrast demonstrated right pneumothorax with the drain tube and a voluminous fluid level (hemopneumothorax), which was causing compression atelectasis of the right lower lobe. The pneumothorax cavity showed a tract compatible with adhesions, although the bleeding point was not identified. The study was completed with intercostal arterial embolization, and, given the suspicion that the origin of the bleeding was the intercostal arteries of the intercostal space through which the drain tube entered into the thoracic cavity, we decided to perform embolization of their distal ends (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The total discharge was 2100<span class="elsevierStyleHsp" style=""></span>ml bloody fluid; blood work showed a hemoglobin level of 8.6<span class="elsevierStyleHsp" style=""></span>g/dl, requiring blood transfusion and volume replacement. During post-op, the patient progressed favorably from a radiological and clinical standpoint and the tube was withdrawn after 10 days.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Hemothorax is defined as the presence of blood in the pleural space. This term is reserved for cases in which pleural liquid hematocrit levels are at least 50% the hematocrit level of the peripheral blood.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> From an etiologic standpoint, hemothorax is classified as traumatic, non-traumatic or spontaneous and iatrogenic.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Iatrogenic hemothorax after pleural drain placement is a well-known complication, although its frequency has not been well defined in the literature. After thoracocentesis, hemothorax is observed in 0.2%–1% of patients.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">3,4</span></a> Some authors<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a> report that the risk of iatrogenic hemothorax increases with patient age. Other authors<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> have reported that bleeding during thoracocentesis can also be a consequence of a laceration to the collateral intercostal artery (or supracostal branch of the posterior intercostal artery). In our patient, hemothorax was secondary to chest drain insertion, and it was assumed that the cause was a lesion to the intercostal artery.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Massive hemothorax is a rapid accumulation of 1500<span class="elsevierStyleHsp" style=""></span>ml or more in the pleural space. Thoracotomy is the gold-standard treatment in cases of massive hemothorax and persistent thoracic bleeding where the chest discharge is more than 200<span class="elsevierStyleHsp" style=""></span>ml/h for 4<span class="elsevierStyleHsp" style=""></span>h. Thoracotomy is associated with significant morbidity and mortality, and some patients continue bleeding afterwards due to the inability to either identify the bleeding point or completely control the hemorrhage.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Angiographic embolization is an effective alternative to thoracotomy in selected patients as it avoids postoperative complications and high mortality. Conservative treatment involves observation, chest tube placement, volume replacement, analgesic control and, occasionally, ventilatory support. In the last 2 decades, selective angiography embolization after localization of the bleeding vessel has been accepted and recommended as an alternative treatment in the management of patients who continue to bleed, but who respond to fluid resuscitation. The recent use of CT angiography combined with CT and intravenous contrast is a non-invasive method to determine the site of the hemorrhage, which can be followed by surgical or endovascular treatment.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">To conclude, in iatrogenic hemothorax, interventional radiology provides a minimally invasive approach associated with few complications and a high rate of success in hemodynamically stable patients. Our case is interesting because of the successful use of embolization of the intercostal arteries.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Motos-Micó JJ, Alves-Conciecao T, López-Martínez L, Fuentes-Porcel O, Rosado-Cobián R. Embolización de arterias intercostales en un hemotórax iatrogénico. Cir Esp. 2015;93:340–341.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 882 "Ancho" => 995 "Tamanyo" => 144487 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Posteroanterior chest radiograph: large right hydropneumothorax with moderate lung collapse and air-fluid level that reaches the right mid-lung.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 893 "Ancho" => 995 "Tamanyo" => 160767 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Intercostal artery embolization: embolization of the distal part of the intercostal arteries of the intercostal space through which the drain tube enters the thoracic cavity.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Massive iatrogenic haemothorax treated by lidocaïne-adrenaline intercostal injection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 71 | 3 | 74 |
| 2024 September | 83 | 12 | 95 |
| 2024 August | 88 | 12 | 100 |
| 2024 July | 63 | 8 | 71 |
| 2024 June | 57 | 3 | 60 |
| 2024 May | 68 | 9 | 77 |
| 2024 April | 71 | 7 | 78 |
| 2024 March | 84 | 5 | 89 |
| 2024 February | 110 | 2 | 112 |
| 2024 January | 137 | 2 | 139 |
| 2023 December | 107 | 3 | 110 |
| 2023 November | 129 | 6 | 135 |
| 2023 October | 153 | 6 | 159 |
| 2023 September | 81 | 5 | 86 |
| 2023 August | 72 | 14 | 86 |
| 2023 July | 76 | 5 | 81 |
| 2023 June | 67 | 0 | 67 |
| 2023 May | 83 | 7 | 90 |
| 2023 April | 81 | 4 | 85 |
| 2023 March | 98 | 5 | 103 |
| 2023 February | 80 | 15 | 95 |
| 2023 January | 90 | 5 | 95 |
| 2022 December | 75 | 3 | 78 |
| 2022 November | 77 | 8 | 85 |
| 2022 October | 69 | 8 | 77 |
| 2022 September | 62 | 6 | 68 |
| 2022 August | 89 | 12 | 101 |
| 2022 July | 64 | 6 | 70 |
| 2022 June | 68 | 8 | 76 |
| 2022 May | 54 | 11 | 65 |
| 2022 April | 63 | 25 | 88 |
| 2022 March | 84 | 9 | 93 |
| 2022 February | 79 | 6 | 85 |
| 2022 January | 92 | 10 | 102 |
| 2021 December | 80 | 15 | 95 |
| 2021 November | 76 | 10 | 86 |
| 2021 October | 87 | 12 | 99 |
| 2021 September | 85 | 21 | 106 |
| 2021 August | 60 | 10 | 70 |
| 2021 July | 61 | 17 | 78 |
| 2021 June | 50 | 22 | 72 |
| 2021 May | 66 | 9 | 75 |
| 2021 April | 199 | 29 | 228 |
| 2021 March | 81 | 13 | 94 |
| 2021 February | 63 | 14 | 77 |
| 2021 January | 75 | 18 | 93 |
| 2020 December | 60 | 7 | 67 |
| 2020 November | 75 | 11 | 86 |
| 2020 October | 48 | 12 | 60 |
| 2020 September | 64 | 17 | 81 |
| 2020 August | 78 | 23 | 101 |
| 2020 July | 44 | 6 | 50 |
| 2020 June | 49 | 14 | 63 |
| 2020 May | 65 | 14 | 79 |
| 2020 April | 50 | 6 | 56 |
| 2020 March | 65 | 12 | 77 |
| 2020 February | 52 | 15 | 67 |
| 2020 January | 70 | 15 | 85 |
| 2019 December | 69 | 15 | 84 |
| 2019 November | 51 | 9 | 60 |
| 2019 October | 55 | 6 | 61 |
| 2019 September | 63 | 9 | 72 |
| 2019 August | 40 | 9 | 49 |
| 2019 July | 49 | 13 | 62 |
| 2019 June | 123 | 19 | 142 |
| 2019 May | 254 | 25 | 279 |
| 2019 April | 104 | 41 | 145 |
| 2019 March | 26 | 11 | 37 |
| 2019 February | 34 | 12 | 46 |
| 2019 January | 31 | 4 | 35 |
| 2018 December | 19 | 6 | 25 |
| 2018 November | 38 | 4 | 42 |
| 2018 October | 69 | 7 | 76 |
| 2018 September | 43 | 5 | 48 |
| 2018 August | 15 | 5 | 20 |
| 2018 July | 16 | 1 | 17 |
| 2018 June | 21 | 3 | 24 |
| 2018 May | 15 | 8 | 23 |
| 2018 April | 28 | 1 | 29 |
| 2018 March | 21 | 2 | 23 |
| 2018 February | 25 | 2 | 27 |
| 2018 January | 22 | 0 | 22 |
| 2017 December | 26 | 4 | 30 |
| 2017 November | 27 | 4 | 31 |
| 2017 October | 21 | 5 | 26 |
| 2017 September | 30 | 6 | 36 |
| 2017 August | 34 | 8 | 42 |
| 2017 July | 32 | 9 | 41 |
| 2017 June | 59 | 17 | 76 |
| 2017 May | 53 | 6 | 59 |
| 2017 April | 35 | 12 | 47 |
| 2017 March | 43 | 24 | 67 |
| 2017 February | 65 | 7 | 72 |
| 2017 January | 26 | 10 | 36 |
| 2016 December | 35 | 9 | 44 |
| 2016 November | 66 | 4 | 70 |
| 2016 October | 63 | 4 | 67 |
| 2016 September | 140 | 6 | 146 |
| 2016 August | 58 | 3 | 61 |
| 2016 July | 46 | 2 | 48 |
| 2016 June | 60 | 14 | 74 |
| 2016 May | 60 | 14 | 74 |
| 2016 April | 42 | 13 | 55 |
| 2016 March | 48 | 18 | 66 |
| 2016 February | 28 | 6 | 34 |
| 2016 January | 30 | 9 | 39 |
| 2015 December | 45 | 10 | 55 |
| 2015 November | 40 | 5 | 45 |
| 2015 October | 37 | 9 | 46 |
| 2015 September | 35 | 9 | 44 |
| 2015 August | 27 | 5 | 32 |
| 2015 July | 1 | 2 | 3 |
| 2015 June | 0 | 1 | 1 |
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