Massive right hemothorax due to idiopathic spontaneous rupture of a phrenic artery following cardiac surgery

Taboada Muñiz, M.; Tubio Pose, A.; Ferreiroa Mosquera, E.; Calvo Rey, A.; Martínez Cereijo, J.M.; Alvarez Escudero, J.
doi:10.1016/j.redare.2018.04.003
 array:24 [
  "pii" => "S2341192918300490"
  "issn" => "23411929"
  "doi" => "10.1016/j.redare.2018.04.003"
  "estado" => "S300"
  "fechaPublicacion" => "2018-05-01"
  "aid" => "891"
  "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
  "copyrightAnyo" => "2017"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "crp"
  "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2018;65:291-3"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 1
    "HTML" => 1
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S003493561730275X"
      "issn" => "00349356"
      "doi" => "10.1016/j.redar.2017.12.005"
      "estado" => "S300"
      "fechaPublicacion" => "2018-05-01"
      "aid" => "891"
      "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "crp"
      "cita" => "Rev Esp Anestesiol Reanim. 2018;65:291-3"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 53
        "formatos" => array:2 [
          "HTML" => 41
          "PDF" => 12
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">CASO CL&#205;NICO</span>"
        "titulo" => "Hemot&#243;rax masivo derecho por rotura espont&#225;nea idiop&#225;tica de una arteria fr&#233;nica tras cirug&#237;a cardiaca"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "291"
            "paginaFinal" => "293"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Massive right hemothorax due to idiopathic spontaneous rupture of a phrenic artery following cardiac surgery"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 1056
                "Ancho" => 2333
                "Tamanyo" => 169645
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">a&#41; Radiograf&#237;a de t&#243;rax con hemot&#243;rax masivo&#46; b&#41; Radiograf&#237;a de t&#243;rax con persistencia de hemot&#243;rax a pesar de drenaje tor&#225;cico &#40;flechas negras&#41; y drenaje de 1&#46;600&#46; mL&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "M&#46; Taboada Mu&#241;iz, A&#46; Tubio Pose, E&#46; Ferreiroa Mosquera, A&#46; Calvo Rey, J&#46; M&#46; Mart&#237;nez Cereijo, J&#46; Alvarez Escudero"
            "autores" => array:6 [
              0 => array:2 [
                "nombre" => "M&#46;"
                "apellidos" => "Taboada Mu&#241;iz"
              ]
              1 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Tubio Pose"
              ]
              2 => array:2 [
                "nombre" => "E&#46;"
                "apellidos" => "Ferreiroa Mosquera"
              ]
              3 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Calvo Rey"
              ]
              4 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "M&#46; Mart&#237;nez Cereijo"
              ]
              5 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Alvarez Escudero"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2341192918300490"
          "doi" => "10.1016/j.redare.2018.04.003"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300490?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S003493561730275X?idApp=UINPBA00004N"
      "url" => "/00349356/0000006500000005/v1_201805080427/S003493561730275X/v1_201805080427/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2341192918300507"
    "issn" => "23411929"
    "doi" => "10.1016/j.redare.2018.04.004"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "894"
    "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2018;65:294-7"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1
      "HTML" => 1
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Cerebral oximetry monitoring in the management of severe hypoxaemia associated with transposition of the great arteries with balloon atrial septostomy"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "294"
          "paginaFinal" => "297"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Monitorizaci&#243;n de la oximetr&#237;a cerebral en el manejo de la hipoxemia severa asociada a la transposici&#243;n de grandes arterias mediante atrioseptostom&#237;a con bal&#243;n"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 801
              "Ancho" => 1583
              "Tamanyo" => 98112
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Case 2&#46; A positive correlation was observed between regional cerebral oxygen saturation &#40;rSO<span class="elsevierStyleInf">2</span>&#41; and serum lactate levels after balloon atrioseptostomy&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;C&#46; P&#233;rez Moreno, D&#46;C&#46; N&#225;jera Losada, P&#46; Sanabria Carretero, &#193;&#46; Paredes Lacave, F&#46; Benito Bartolom&#233;"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "P&#233;rez Moreno"
            ]
            1 => array:2 [
              "nombre" => "D&#46;C&#46;"
              "apellidos" => "N&#225;jera Losada"
            ]
            2 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Sanabria Carretero"
            ]
            3 => array:2 [
              "nombre" => "&#193;&#46;"
              "apellidos" => "Paredes Lacave"
            ]
            4 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Benito Bartolom&#233;"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0034935617302785"
        "doi" => "10.1016/j.redar.2017.12.008"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302785?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300507?idApp=UINPBA00004N"
    "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300507/v1_201805120427/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S2341192918300532"
    "issn" => "23411929"
    "doi" => "10.1016/j.redare.2018.04.006"
    "estado" => "S300"
    "fechaPublicacion" => "2018-05-01"
    "aid" => "885"
    "copyright" => "Sociedad Espa&#241;ola de Anestesiolog&#237;a&#44; Reanimaci&#243;n y Terap&#233;utica del Dolor"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "crp"
    "cita" => "Revista Espa&#241;ola de Anestesiolog&#237;a y Reanimaci&#243;n &#40;English Version&#41;. 2018;65:287-90"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 3
      "formatos" => array:2 [
        "HTML" => 1
        "PDF" => 2
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Continuous erector spinae plane block for analgesia in pediatric thoracic surgery&#58; A case report"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "287"
          "paginaFinal" => "290"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Bloqueo continuo en el plano del m&#250;sculo erector del espinal para analgesia en cirug&#237;a tor&#225;cica pedi&#225;trica&#58; informe de un caso"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1267
              "Ancho" => 1267
              "Tamanyo" => 167299
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Patient in left lateral decubitus with landmarking marks&#46; T5&#8211;T5 spinous process&#59; T7&#8211;T7 spinous process&#59; arrow&#8211;tip of the scapula&#59; A&#8211;site for probe placement in a longitudinal parasagittal orientation&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#46; Gaio-Lima, C&#46;C&#46; Costa, J&#46;B&#46; Moreira, T&#46;S&#46; Lemos, H&#46;L&#46; Trindade"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Gaio-Lima"
            ]
            1 => array:2 [
              "nombre" => "C&#46;C&#46;"
              "apellidos" => "Costa"
            ]
            2 => array:2 [
              "nombre" => "J&#46;B&#46;"
              "apellidos" => "Moreira"
            ]
            3 => array:2 [
              "nombre" => "T&#46;S&#46;"
              "apellidos" => "Lemos"
            ]
            4 => array:2 [
              "nombre" => "H&#46;L&#46;"
              "apellidos" => "Trindade"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0034935617302694"
        "doi" => "10.1016/j.redar.2017.11.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302694?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300532?idApp=UINPBA00004N"
    "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300532/v1_201805120427/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
    "titulo" => "Massive right hemothorax due to idiopathic spontaneous rupture of a phrenic artery following cardiac surgery"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "291"
        "paginaFinal" => "293"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "M&#46; Taboada Mu&#241;iz, A&#46; Tubio Pose, E&#46; Ferreiroa Mosquera, A&#46; Calvo Rey, J&#46;M&#46; Mart&#237;nez Cereijo, J&#46; Alvarez Escudero"
        "autores" => array:6 [
          0 => array:4 [
            "nombre" => "M&#46;"
            "apellidos" => "Taboada Mu&#241;iz"
            "email" => array:1 [
              0 => "manutabo&#64;yahoo&#46;es"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Tubio Pose"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "E&#46;"
            "apellidos" => "Ferreiroa Mosquera"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "A&#46;"
            "apellidos" => "Calvo Rey"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Mart&#237;nez Cereijo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Alvarez Escudero"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Unidad de Cuidados Cr&#237;ticos Postoperatorios&#44; Servicio de Anestesia&#44; Reanimaci&#243;n y Tratamiento del Dolor&#44; Hospital Cl&#237;nico Universitario de Santiago&#44; Santiago de Compostela&#44; Galicia&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Cirug&#237;a Cardiaca&#44; Hospital Cl&#237;nico Universitario de Santiago&#44; Santiago de Compostela&#44; Galicia&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hemot&#243;rax masivo derecho por rotura espont&#225;nea idiop&#225;tica de una arteria fr&#233;nica tras cirug&#237;a cardiaca"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1271
            "Ancho" => 2333
            "Tamanyo" => 267514
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Contrast-enhanced computed tomography&#46; Active intrathoracic bleeding in the right hemithorax &#40;white arrow&#41; with significant haemothorax and clots that displaced liver and right kidney&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Haemothorax caused by spontaneous rupture of a phrenic artery is a very rare entity that requires prompt diagnosis and treatment to avoid hypovolemic shock and death&#46; In most cases published so far&#44; rupture of a phrenic artery is usually associated with blunt chest trauma&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> We present the case of a patient with late postoperative spontaneous rupture of the right phrenic artery with massive haemothorax and hypovolemic shock after cardiac surgery&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 35-year-old man with no medical history of interest&#44; admitted for endocarditis on a bicuspid aortic valve complicated by aortic vein perforation and severe aortic insufficiency&#46; The patient underwent a metallic aortic valve replacement &#40;carbamedics number 25&#41;&#46; The surgery was uneventful&#46; The patient was extubated after 6<span class="elsevierStyleHsp" style=""></span>h and discharged to the hospital ward 24<span class="elsevierStyleHsp" style=""></span>h after surgery&#46; Anticoagulation was started with 60<span class="elsevierStyleHsp" style=""></span>mg enoxaparin&#47;12<span class="elsevierStyleHsp" style=""></span>h and low-dose acenocumarine&#46; On the seventh postoperative day&#44; while on the ward&#44; the patient and reported severe right chest pain radiating to the axila and respiratory distress&#46; Blood tests showed Hb&#58; 9&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#44; INR&#58; 1&#46;45<span class="elsevierStyleHsp" style=""></span>s&#44; PT time&#58; 1&#46;46<span class="elsevierStyleHsp" style=""></span>s&#44; and 500&#44;000 platelets&#46; The patient&#39;s blood pressure fell to 70&#47;45<span class="elsevierStyleHsp" style=""></span>mmHg&#44; with poor response to fluid replacement&#46; Norepinephrine perfusion was started and the patient was admitted to the postoperative Critical Care Unit &#40;CCU&#41;&#46; Right femoral artery and right internal jugular vein lines were placed for monitoring&#44; together with peripheral lines were placed for fluid replacement&#46; On arrival at the CCU Hb was 4&#46;6<span class="elsevierStyleHsp" style=""></span>g&#47;dl&#46; Transfusion of packed red blood cells and fresh plasma was started&#46; The transthoracic echocardiogram ruled out cardiac tamponade&#44; and massive right haemothorax was diagnosed after chest X-ray and chest ultrasound &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#41;&#46; The patient was intubated and a chest tube was immediately inserted in the right haemothorax&#44; through which 1600<span class="elsevierStyleHsp" style=""></span>ml of blood were collected&#46; The chest radiograph was repeated&#44; observing the persistence of massive haemothorax &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>b&#41;&#46; We decided to perform urgent contrast-enhanced computerised axial tomography&#44; which showed active right-sided intrathoracic bleeding with major haemothorax and clots that displaced the liver and right kidney &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; The cardiac&#44; thoracic and interventional radiology services were contacted&#44; and in view of the patient&#39;s haemodynamic and respiratory instability&#44; urgent surgical intervention was decided&#46; A median sternotomy was performed&#44; with no sign of complications in the aorta and inferior vena cava&#46; The right pleural cavity was opened&#44; and abundant clots and blood were drained from the right hemithorax&#46; Active bleeding from a phrenic artery at the base of the right diaphragm was observed&#46; The artery was ligated&#44; and good haemostatic control was achieved&#46; The surgery was completed and the patient was transferred to the CCU&#46; The patient received in total 10 bags of packed red blood cells and 9 of fresh plasma&#46; Postoperative progress was good enough to allow withdrawal of catecholamines and extubation at 8<span class="elsevierStyleHsp" style=""></span>h after surgery&#44; followed by transfer to the ward 48<span class="elsevierStyleHsp" style=""></span>h after surgery&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Haemothorax after cardiac surgery is a relatively frequent entity that is usually associated with bleeding caused by dissection of the mammary artery in patients undergoing coronary revascularisation&#59; with damage to an intercostal artery during placement of an intrathoracic tube&#59; or as a complication of central venous access&#46; In this case&#44; the patient presented massive haemothorax due to spontaneous rupture of a phrenic artery on the seventh postoperative day after cardiac surgery&#46; Previous studies have described haemothorax due to rupture of a phrenic artery after blunt trauma&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> Rupture of intrathoracic vessels has also been associated with diseases such as Ehlers Danlos&#44; Marfan or neurofibromatosis type 1&#44; which weaken the arterial wall and lead to the formation of aneurysms&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In the few reports of haemothorax caused by spontaneous rupture of intrathoracic vessels and not by trauma or associated disease&#44; bleeding was due to rupture of an intercostal artery&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> Barau et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> recently described a case of spontaneous haemothorax due to rupture of a phrenic artery 30<span class="elsevierStyleHsp" style=""></span>h after cardiac surgery&#46; The authors believe that several factors could have contributed to the rupture&#44; such as the administration of anticoagulants during cardiopulmonary bypass&#44; or the shearing of pleural adhesions&#46; Spontaneous haemothorax is sometimes preceded by spontaneous pneumothorax that causes the shearing of adhesions between the parietal and the visceral pleura&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> In our patient&#44; the rupture of the phrenic artery occurred 7 days after the surgery&#46; Anticoagulation with acenocoumarin&#44; which was started on the third day despite low INR and PT&#44; could have contributed to the magnitude of the haemothorax&#46; The mechanism by which the phrenic artery is injured is unclear&#59; however&#44; it has been reported that spontaneous rupture of intrathoracic vessels may be associated with sustained hypertension&#44; atelectasis&#44; pulmonary infections&#44; strenuous pulmonary physiotherapy or violent coughing&#44; particularly in anticoagulated patients&#46; We do not believe that any of these factors contributed to spontaneous rupture of the phrenic artery in our patient&#46; Jang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> described a case of spontaneous rupture of an intercostal artery in a patient with no history of trauma or illness&#44; but with severe cough lasting several days&#46; The ruptured artery was treated with arteriography and embolisation&#46; Although transcatheter arterial embolisation could be an effective approach&#44; in our case we decided to perform sternotomy to control the bleeding and drain the abundant thoracic clots due to the patient&#39;s severe haemodynamic and respiratory instability&#46; To conclude&#44; spontaneous rupture of a phrenic artery is extremely rare&#44; but can lead to massive haemothorax and hypovolaemic shock&#46; Early diagnosis and prompt treatment can be life-saving&#46; The presence of sudden spontaneous chest pain associated with respiratory distress and haemodynamic deterioration is a warning sign of this rare&#44; but not unknown&#44; complication&#46; Emergency CT&#44; or better still&#44; a CT angiogram&#44; can be of great help in locating the origin of the bleed and will rule out the presence of vascular malformations&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:9 [
        0 => array:3 [
          "identificador" => "xres1024785"
          "titulo" => "Abstract"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0005"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec982679"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1024786"
          "titulo" => "Resumen"
          "secciones" => array:1 [
            0 => array:1 [
              "identificador" => "abst0010"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec982680"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Case report"
        ]
        6 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Discussion"
        ]
        7 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conflicts of interest"
        ]
        8 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-10-24"
    "fechaAceptado" => "2017-12-12"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec982679"
          "palabras" => array:3 [
            0 => "Phrenic artery"
            1 => "Haemothorax"
            2 => "Cardiac surgery"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec982680"
          "palabras" => array:3 [
            0 => "Arteria fr&#233;nica"
            1 => "Hemot&#243;rax"
            2 => "Cirug&#237;a cardiaca"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We report a case of a 35-years-old man who presented a massive haemothorax and hypovolemic shock following cardiac surgery&#44; from spontaneous rupture of a phrenic artery&#46; A quick diagnosis and immediate intervention is crucial to manage the patient&#46;</p></span>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Presentamos el caso de un hombre de 35 a&#241;os que en el postoperatorio de cirug&#237;a cardiaca presenta un hemot&#243;rax masivo y shock hipovol&#233;mico por rotura espont&#225;nea de una arteria fr&#233;nica&#46; Un r&#225;pido diagn&#243;stico y una inmediata intervenci&#243;n son cruciales para el manejo del paciente&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Taboada Mu&#241;iz M&#44; Tubio Pose A&#44; Ferreiroa Mosquera E&#44; Calvo Rey A&#44; Mart&#237;nez Cereijo JM&#44; Alvarez Escudero J&#46; Hemot&#243;rax masivo derecho por rotura espont&#225;nea idiop&#225;tica de una arteria fr&#233;nica tras cirug&#237;a cardiaca&#46; Rev Esp Anestesiol Reanim&#46; 2018&#59;65&#58;291&#8211;293&#46;</p>"
      ]
    ]
    "multimedia" => array:2 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1056
            "Ancho" => 2333
            "Tamanyo" => 178840
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Chest X-ray showing massive haemothorax&#46; &#40;b&#41; Chest X-ray showing persistence of haemothorax despite insertion of a chest tube &#40;black arrows&#41; and drainage of 1600<span class="elsevierStyleHsp" style=""></span>ml&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 1271
            "Ancho" => 2333
            "Tamanyo" => 267514
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Contrast-enhanced computed tomography&#46; Active intrathoracic bleeding in the right hemithorax &#40;white arrow&#41; with significant haemothorax and clots that displaced liver and right kidney&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Report of a rare case&#58; occult hemothorax due to blunt trauma without obvious injury to other organs"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Ogawa"
                            1 => "M&#46; Naito"
                            2 => "A&#46; Iyoda"
                            3 => "Y&#46; Satoh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1749-8090-8-205"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiothorac Surg"
                        "fecha" => "2013"
                        "volumen" => "8"
                        "paginaInicial" => "205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24176006"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Massive hemothorax due to inferior phrenic artery injury after blunt trauma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Aoki"
                            1 => "K&#46; Shibuya"
                            2 => "M&#46; Kaneko"
                            3 => "A&#46; Koizumi"
                            4 => "M&#46; Murata"
                            5 => "J&#46; Nakajima"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13017-015-0052-3"
                      "Revista" => array:5 [
                        "tituloSerie" => "World J Emerg Surg"
                        "fecha" => "2015"
                        "volumen" => "10"
                        "paginaInicial" => "58"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26604982"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Etiology and management of spontaneous haemothorax"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46; Patrini"
                            1 => "N&#46; Panagiotopoulos"
                            2 => "J&#46; Pararajasingham"
                            3 => "L&#46; Gvinianidze"
                            4 => "Y&#46; Igbal"
                            5 => "D&#46;R&#46; Lawrence"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3978/j.issn.2072-1439.2014.12.50"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Dis"
                        "fecha" => "2015"
                        "volumen" => "7"
                        "paginaInicial" => "520"
                        "paginaFinal" => "526"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25922734"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Idiopathic spontaneous rupture of an intercostal artery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Dua"
                            1 => "A&#46; Dua"
                            2 => "S&#46; Jecho"
                            3 => "S&#46;S&#46; Deasi"
                            4 => "S&#46; Kuy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "WMJ"
                        "fecha" => "2014"
                        "volumen" => "113"
                        "paginaInicial" => "116"
                        "paginaFinal" => "118"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25118440"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous hemothorax following cardiac surgery"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46; Barua"
                            1 => "R&#46; Brown"
                            2 => "S&#46; Puppala"
                            3 => "D&#46;J&#46; O&#8217;Regan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Cardiac Surg"
                        "fecha" => "2016"
                        "volumen" => "31"
                        "paginaInicial" => "211"
                        "paginaFinal" => "213"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Spontaneous rupture of intercostal artery after severe cough"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;Y&#46; Jang"
                            1 => "Y&#46;S&#46; Lim"
                            2 => "J&#46;H&#46; Woo"
                            3 => "J&#46;H&#46; Jang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ajem.2014.06.033"
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Emerg Med"
                        "fecha" => "2015"
                        "volumen" => "33"
                        "paginaInicial" => "131"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25085284"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/23411929/0000006500000005/v1_201805120427/S2341192918300490/v1_201805120427/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "67195"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Case Reports"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000005/v1_201805120427/S2341192918300490/v1_201805120427/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300490?idApp=UINPBA00004N"
]
Indexed in:

Follow us:

Subscribe:

Article

Indexed in:

Follow us:

Subscribe:

Article

Subscribe to our newsletter
