CASE REPORTS  THORACIC PAPERS 

The Journal of Cardiovascular Surgery 1998 December;39(6):869-71

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

A case of ruptured descending thoracic aortic aneurysm into the right pleural cavity: importance of preoperative drainage of the right pleural cavity

Akiyama K., Takazawa A., Hirota J., Yamagishi H., Akazawa T.

From the Department of Cardiovascular Surgery Iwaki Kyoritsu General Hospital

We ­present an ­unusual ­case of a rup­tured ­descending tho­racic ­aortic aneu­rysm ­into the ­right ­pleural ­cavity of a ­patient ­with ­pectus car­i­natum. The pres­ence of ­pectus car­i­natum ­played an impor­tant ­role in the devel­op­ment of the aneu­rysm at the atyp­ical ­site and the rup­ture ­into the ­right ­pleural ­cavity. A ­small ­amount of ­right ­pleural ­bleeding on admis­sion can ­increase and ­develop to mas­sive hemo­thorax ­until emer­gency oper­a­tion. Mas­sive ­bleeding in the ­right ­pleural ­cavity ­where the depen­dent ­lung is ­located ­causes ate­lec­tasis and ­increased ­shunt frac­tion ­under one ­lung ven­ti­la­tion. There­fore, con­tin­uous ­drainage of the ­right ­pleural ­cavity is essen­tial to pre­vent ­serious ­hypoxia ­during ­graft replace­ment in a ­case of rup­tured ­descending tho­racic aneu­rysm ­into the ­right hem­i­thorax.