Ctガイド下肺生検術で大量血胸に至り緊急手術を要した1例

Abstract

An 81-year-old male with a history of chronic atrial fibrillation, idiopathic interstitial pneumonia, and chronic obstructive pulmonary disease was treated with prednisolone and apixaban. Chest computed tomography (CT) revealed a 1.7cm nodule in the left lower lobe. CT-guided needle biopsy (CTNB) with an 18-gauge biopsy needle was performed more than 24 h after discontinuing apixaban. We inserted a small-bore chest tube (12 Fr), because of pneumothorax. Consequently, the patient developed shock three hours after CTNB. Chest CT revealed a massive left-sided hemothorax. We performed video-assisted thoracic surgery and removed approximately 600 mL of blood. Blood oozing from the visceral pleura and underlying pulmonary parenchyma was detected at the left lower lobe, possibly at the biopsy needle insertion site, and was coagulated with electrocautery. He was discharged 9 days after the thoracic surgery. CTNB-induced hemothorax, which is often attributed to intercoastal or internal mammary arteries or veins, can be induced from visceral pleura and underlying pulmonary parenchyma, as in this case, but this is a rare and fatal complication.