EURORAD ESR

Case 15811

Iatrogenic haemothorax following thoracentesis

Author(s)
Tonolini Massimo, MD.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
female, 57 year(s)
 
 
  • Figure 1
    Pre-thoracentesis unenhanced chest CT
     

    Before thoracentesis, unenhanced CT showed bilateral fluid-attenuation (5-8 Hounsfield units) pleural effusions (*) and atelectatic consolidations of lower lung lobes. Additionally, significant pericardial effusion...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    Before thoracentesis, unenhanced CT showed bilateral fluid-attenuation (5-8 Hounsfield units) pleural effusions (*) and atelectatic consolidations of lower lung lobes. Note small-sized kidneys with urinary stents...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Emergency pre- and postcontrast CT after left-sided thoracentesis
     

    Compared to Fig.1, repeated CT after thoracentesis showed near-complete atelectasis of left lung, appearance of some intrapleural air (o) and contralateral dislocation of mediastinal structures.

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    On precontrast images (b,c), the left-sided pleural effusion (large *) was markedly increased with appearaance of hyperattenuating (mean 35-40 HU) components consistent with haemothorax. Note stable findings at...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    On precontrast images (b,c), the left-sided pleural effusion (large *) was markedly increased with appearaance of hyperattenuating (mean 35-40 HU) components consistent with haemothorax.

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    Coronal post-contrast viewing effectively showed markedly increased, inhomogeneous left pleural effusion (large *) causing near-complete lung atelectasis, contralateral mediastinal displacement and downwards...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    Additionally, a sizeable focus of contrast medium extravasation (arrowheads) indicating active bleeding was visible within haemothorax (large *), originating from the visceral pleura.

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    Additionally, a sizeable focus of contrast medium extravasation (arrowheads) indicating active bleeding was visible within haemothorax (large *), originating from the visceral pleura. Note downwards displacement of...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    a

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;
     
     
  • Figure 3
    Repeated pre- and postcontrast chest CT after tube drainage
     

    24 hours after Fig.2, CT showed tracheal intubation, positioning of left pleural drainage tube (thick arrows), partial re-expansion of left lung and decreased mediastinal displacement.

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    24 hours after Fig.2, CT showed tracheal intubation, positioning of left pleural drainage tube (thick arrows), partial re-expansion of left lung and decreased mediastinal displacement. Note moderately decreased...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    On precontrast images, the moderately decreased haemothorax (large *) still contained hyperattenuation bloody components.

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    After iv contrast, the focal contrast extravasation at visceral pleura (arrowheads) within haemothorax (large *) was markedly decreased in size compared to Fig.2. Note pleural drainage (thick arrows), pericardial...

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;

    After iv contrast, the focal contrast extravasation at visceral pleura (arrowheads) within haemothorax was markedly decreased in size compared to Fig.2.

     
    Area of Interest: Lung; Imaging Technique: CT; Procedure: Drainage; Special Focus: Haemorrhage;
     
     
Before thoracentesis, unenhanced CT showed bilateral fluid-attenuation (5-8 Hounsfield units) pleural effusions (*) and atelectatic consolidations of lower lung lobes. Additionally, significant pericardial effusion (+) was present.
 
Before thoracentesis, unenhanced CT showed bilateral fluid-attenuation (5-8 Hounsfield units) pleural effusions (*) and atelectatic consolidations of lower lung lobes. Note small-sized kidneys with urinary stents (thick arrows) in place.
 
Compared to Fig.1, repeated CT after thoracentesis showed near-complete atelectasis of left lung, appearance of some intrapleural air (o) and contralateral dislocation of mediastinal structures.
 
On precontrast images (b,c), the left-sided pleural effusion (large *) was markedly increased with appearaance of hyperattenuating (mean 35-40 HU) components consistent with haemothorax. Note stable findings at right lung base (*) and pericardial effusion (+).
 
On precontrast images (b,c), the left-sided pleural effusion (large *) was markedly increased with appearaance of hyperattenuating (mean 35-40 HU) components consistent with haemothorax.
 
Coronal post-contrast viewing effectively showed markedly increased, inhomogeneous left pleural effusion (large *) causing near-complete lung atelectasis, contralateral mediastinal displacement and downwards dislocation of hemidiaphragm. Note pericardial effusion (+).
 
Additionally, a sizeable focus of contrast medium extravasation (arrowheads) indicating active bleeding was visible within haemothorax (large *), originating from the visceral pleura.
 
Additionally, a sizeable focus of contrast medium extravasation (arrowheads) indicating active bleeding was visible within haemothorax (large *), originating from the visceral pleura. Note downwards displacement of left hemidiaphragm.
 
a
 
24 hours after Fig.2, CT showed tracheal intubation, positioning of left pleural drainage tube (thick arrows), partial re-expansion of left lung and decreased mediastinal displacement.
 
24 hours after Fig.2, CT showed tracheal intubation, positioning of left pleural drainage tube (thick arrows), partial re-expansion of left lung and decreased mediastinal displacement. Note moderately decreased haemothorax (large *), persistent pericardial effusion (+).
 
On precontrast images, the moderately decreased haemothorax (large *) still contained hyperattenuation bloody components.
 
After iv contrast, the focal contrast extravasation at visceral pleura (arrowheads) within haemothorax (large *) was markedly decreased in size compared to Fig.2. Note pleural drainage (thick arrows), pericardial effusion (+), right pleural effusion (*) and atelectasis.
 
After iv contrast, the focal contrast extravasation at visceral pleura (arrowheads) within haemothorax was markedly decreased in size compared to Fig.2.
 
 
 
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