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Hemothorax caused by rupture of pericardiophrenic vein varix
Journal Pre-proof Hemothorax caused by rupture of pericardiophrenic vein varix Wei Dong, MD, PhD, Wei Ma, MD, PhD, Jiajun Du, MD, PhD PII:
S0003-4975(19)31760-6
DOI:
https://doi.org/10.1016/j.athoracsur.2019.10.022
Reference:
ATS 33262
To appear in:
The Annals of Thoracic Surgery
Received Date: 19 August 2019 Revised Date:
18 September 2019
Accepted Date: 5 October 2019
Please cite this article as: Dong W, Ma W, Du J, Hemothorax caused by rupture of pericardiophrenic vein varix, The Annals of Thoracic Surgery (2019), doi: https://doi.org/10.1016/j.athoracsur.2019.10.022. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 by The Society of Thoracic Surgeons
Hemothorax caused by rupture of pericardiophrenic vein varix
Wei Dong, MD, PhD, Wei Ma, MD, PhD, Jiajun Du, MD, PhD
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
Address for correspondence to Jiajun Du, Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, China；email: [email protected]
1
A 52-year-old male with hypertension and heavy drinking history presented to the emergency department for chest pain and severe respiratory distress. On examination he had reduced respiratory tone on the left side, hemoglobin 90 g/L (120~160g/L), plates 95×109/L, albumin 34.8 g/L, basically normal liver function and slightly prolonged prothrombin time. Contrast-enhanced CT showed massive pleural effusion and severe atelectasis. Unusually, there was a well-enhanced and sharply-defined mass (Fig 1A), emerged from apex of diaphragm, along with the left pericardium
to
the
brachiocephalic
vein.
During
exploratory
thoracotomy,
pericardiophrenic vein varix was found, the bleeding point located in the expansive site and ruptured vessel was removed (Fig 1C). The patient recovered and discharged from hospital three days later. Pericardiophrenic vein varix was an uncommon reason for pulmonary mass [1]. In this case, severe liver cirrhosis took place during long time heavy drinking, and collateral circulation including increasingly serious pericardiophrenic vein varix was formed [2]. However, it's remarkable in this case that there was also a dilated vein in the right thorax (Fig 1B), so active treatment of portal hypertension was probably necessary to avoid potential bleeding for this patient and those who were bearing pericardiophrenic vein varix.
2
References 1. Urpek G, Susam S, Tulumen R, et al. A pericardiophrenic vein varix mimicking a pulmonary mass. J Thorac Oncol 2009;4:889-890. 2. Widrich WC, Srinivasan M, Semine MC, et al. Collateral pathways of the left gastric vein in portal hypertension. AJR Am J Roentgenol 1984;142:375-382.
3
S0003-4975(19)31760-6
DOI:
https://doi.org/10.1016/j.athoracsur.2019.10.022
Reference:
ATS 33262
To appear in:
The Annals of Thoracic Surgery
Received Date: 19 August 2019 Revised Date:
18 September 2019
Accepted Date: 5 October 2019
Please cite this article as: Dong W, Ma W, Du J, Hemothorax caused by rupture of pericardiophrenic vein varix, The Annals of Thoracic Surgery (2019), doi: https://doi.org/10.1016/j.athoracsur.2019.10.022. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 by The Society of Thoracic Surgeons
Hemothorax caused by rupture of pericardiophrenic vein varix
Wei Dong, MD, PhD, Wei Ma, MD, PhD, Jiajun Du, MD, PhD
Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
Address for correspondence to Jiajun Du, Department of Thoracic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, China；email: [email protected]
1
A 52-year-old male with hypertension and heavy drinking history presented to the emergency department for chest pain and severe respiratory distress. On examination he had reduced respiratory tone on the left side, hemoglobin 90 g/L (120~160g/L), plates 95×109/L, albumin 34.8 g/L, basically normal liver function and slightly prolonged prothrombin time. Contrast-enhanced CT showed massive pleural effusion and severe atelectasis. Unusually, there was a well-enhanced and sharply-defined mass (Fig 1A), emerged from apex of diaphragm, along with the left pericardium
to
the
brachiocephalic
vein.
During
exploratory
thoracotomy,
pericardiophrenic vein varix was found, the bleeding point located in the expansive site and ruptured vessel was removed (Fig 1C). The patient recovered and discharged from hospital three days later. Pericardiophrenic vein varix was an uncommon reason for pulmonary mass [1]. In this case, severe liver cirrhosis took place during long time heavy drinking, and collateral circulation including increasingly serious pericardiophrenic vein varix was formed [2]. However, it's remarkable in this case that there was also a dilated vein in the right thorax (Fig 1B), so active treatment of portal hypertension was probably necessary to avoid potential bleeding for this patient and those who were bearing pericardiophrenic vein varix.
2
References 1. Urpek G, Susam S, Tulumen R, et al. A pericardiophrenic vein varix mimicking a pulmonary mass. J Thorac Oncol 2009;4:889-890. 2. Widrich WC, Srinivasan M, Semine MC, et al. Collateral pathways of the left gastric vein in portal hypertension. AJR Am J Roentgenol 1984;142:375-382.
3