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
症例は慢性心房細動と特発性間質性肺炎，慢性閉塞性肺疾患の既往を有し，プレドニゾロン及びアピキサバン内服中の81歳，男性．胸部CTで左下葉に1.7 cmの結節を認め，CTガイド下生検を施行した．アピキサバンは検査の24時間前に中止し，18ゲージの生検針にて1回穿刺した．穿刺時に気胸が発生し，12 Frアスピレーションチューブを挿入して検査を中止した．3時間後にショックバイタルになり，胸部単純X線及びCTで左大量血胸が確認され，緊急で胸腔鏡下血腫除去術及び止血術を行った．約600 mLの血液を除去し，左下葉穿刺部から非拍動性出血が認められ，焼灼凝固にて止血した．周術期合併症なく術後9日目に退院した...
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| Published in | 日本呼吸器外科学会雑誌 Vol. 36; no. 7; pp. 785 - 790 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本呼吸器外科学会
15.11.2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0919-0945 1881-4158 |
| DOI | 10.2995/jacsurg.36.785 |
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| Abstract | 症例は慢性心房細動と特発性間質性肺炎，慢性閉塞性肺疾患の既往を有し，プレドニゾロン及びアピキサバン内服中の81歳，男性．胸部CTで左下葉に1.7 cmの結節を認め，CTガイド下生検を施行した．アピキサバンは検査の24時間前に中止し，18ゲージの生検針にて1回穿刺した．穿刺時に気胸が発生し，12 Frアスピレーションチューブを挿入して検査を中止した．3時間後にショックバイタルになり，胸部単純X線及びCTで左大量血胸が確認され，緊急で胸腔鏡下血腫除去術及び止血術を行った．約600 mLの血液を除去し，左下葉穿刺部から非拍動性出血が認められ，焼灼凝固にて止血した．周術期合併症なく術後9日目に退院した．血胸はCTガイド下生検後の非常に稀な合併症であり，肋間動静脈や内胸動静脈に起因することが多いが，本症例のように肺実質から出血することがあるため．CT下生検後は血胸の発生も念頭におく必要がある． |
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| AbstractList | 症例は慢性心房細動と特発性間質性肺炎，慢性閉塞性肺疾患の既往を有し，プレドニゾロン及びアピキサバン内服中の81歳，男性．胸部CTで左下葉に1.7 cmの結節を認め，CTガイド下生検を施行した．アピキサバンは検査の24時間前に中止し，18ゲージの生検針にて1回穿刺した．穿刺時に気胸が発生し，12 Frアスピレーションチューブを挿入して検査を中止した．3時間後にショックバイタルになり，胸部単純X線及びCTで左大量血胸が確認され，緊急で胸腔鏡下血腫除去術及び止血術を行った．約600 mLの血液を除去し，左下葉穿刺部から非拍動性出血が認められ，焼灼凝固にて止血した．周術期合併症なく術後9日目に退院した．血胸はCTガイド下生検後の非常に稀な合併症であり，肋間動静脈や内胸動静脈に起因することが多いが，本症例のように肺実質から出血することがあるため．CT下生検後は血胸の発生も念頭におく必要がある． |
| Author | 井伊, 庸弘 岩﨑, 雅 濱田, 哲 松元, 亮二 |
| Author_xml | – sequence: 1 fullname: 濱田, 哲 organization: 京都大学大学院医学研究科呼吸不全先進医療講座 – sequence: 1 fullname: 岩﨑, 雅 organization: 綾部市立病院呼吸器外科 – sequence: 1 fullname: 井伊, 庸弘 organization: 綾部市立病院呼吸器外科 – sequence: 1 fullname: 松元, 亮二 organization: 綾部市立病院放射線科 |
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| References | 10. Sekine A, Satoh H, Baba T, Ikeda S, Okuda R, Shinohara T, et al. Safety and efficacy of S-1 in combination with carboplatin in non-small cell lung cancer patients with interstitial lung disease: a pilot study. Cancer Chemother Pharmacol 2016; 77: 1245-52. 1. Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 2006; 59: 60-4. 8. Shukuya T, Ishiwata T, Hara M, Muraki K, Shibayama R, Koyama R, et al. Carboplatin plus weekly paclitaxel treatment in non-small cell lung cancer patients with interstitial lung disease. Anticancer Res 2010; 30: 4357-61. 4. Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol 2011; 196: 678-82. 5. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58: 920-36. 3. Doyle T, Mullerworth M. Bleeding as a complication of fine needle lung biopsy. Thorax 1988; 43: 1013-4. 12. Ogura T, Takigawa N, Tomii K, Kishi K, Inoue Y, Ichihara E, et al. Summary of the Japanese Respiratory Society statement for the treatment of lung cancer with comorbid interstitial pneumonia. Respir Investig 2019; 57: 512-33. 6. Sato T, Kondo H, Watanabe A, Nakajima J, Niwa H, Horio H, et al. A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients. Gen Thorac Cardiovasc Surg 2015; 63: 164-72. 2. Huang WM, Lin HC, Chen CH, Chen CW, Wang CH, Huang CY, et al. Massive hemothorax after computed tomography-guided lung tumor biopsy: An unusual but disastrous complication. Thorac Cancer 2018; 9: 892-6. 11. Watanabe N, Niho S, Kirita K, Umemura S, Matsumoto S, Yoh K, et al. Vinorelbine and cisplatin in patients with advanced non-small cell lung cancer with interstitial pneumonia. Anticancer Res 2015; 35: 1697-701. 7. McDowell BJ, Karamchandani K, Lehman EB, Conboy MJ, Carr ZJ. Perioperative risk factors in patients with idiopathic pulmonary fibrosis: a historical cohort study. Can J Anaesth 2021; 68: 81-91. 9. Kenmotsu H, Naito T, Mori K, Ko R, Ono A, Wakuda K, et al. Effect of platinum-based chemotherapy for non-small cell lung cancer patients with interstitial lung disease. Cancer Chemother Pharmacol 2015; 75: 521-6. |
| References_xml | – reference: 1. Tomiyama N, Yasuhara Y, Nakajima Y, Adachi S, Arai Y, Kusumoto M, et al. CT-guided needle biopsy of lung lesions: a survey of severe complication based on 9783 biopsies in Japan. Eur J Radiol 2006; 59: 60-4. – reference: 5. Manhire A, Charig M, Clelland C, Gleeson F, Miller R, Moss H, et al. Guidelines for radiologically guided lung biopsy. Thorax 2003; 58: 920-36. – reference: 4. Wu CC, Maher MM, Shepard JA. Complications of CT-guided percutaneous needle biopsy of the chest: prevention and management. AJR Am J Roentgenol 2011; 196: 678-82. – reference: 6. Sato T, Kondo H, Watanabe A, Nakajima J, Niwa H, Horio H, et al. A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients. Gen Thorac Cardiovasc Surg 2015; 63: 164-72. – reference: 7. McDowell BJ, Karamchandani K, Lehman EB, Conboy MJ, Carr ZJ. Perioperative risk factors in patients with idiopathic pulmonary fibrosis: a historical cohort study. Can J Anaesth 2021; 68: 81-91. – reference: 8. Shukuya T, Ishiwata T, Hara M, Muraki K, Shibayama R, Koyama R, et al. Carboplatin plus weekly paclitaxel treatment in non-small cell lung cancer patients with interstitial lung disease. Anticancer Res 2010; 30: 4357-61. – reference: 9. Kenmotsu H, Naito T, Mori K, Ko R, Ono A, Wakuda K, et al. Effect of platinum-based chemotherapy for non-small cell lung cancer patients with interstitial lung disease. Cancer Chemother Pharmacol 2015; 75: 521-6. – reference: 12. Ogura T, Takigawa N, Tomii K, Kishi K, Inoue Y, Ichihara E, et al. Summary of the Japanese Respiratory Society statement for the treatment of lung cancer with comorbid interstitial pneumonia. Respir Investig 2019; 57: 512-33. – reference: 2. Huang WM, Lin HC, Chen CH, Chen CW, Wang CH, Huang CY, et al. Massive hemothorax after computed tomography-guided lung tumor biopsy: An unusual but disastrous complication. Thorac Cancer 2018; 9: 892-6. – reference: 10. Sekine A, Satoh H, Baba T, Ikeda S, Okuda R, Shinohara T, et al. Safety and efficacy of S-1 in combination with carboplatin in non-small cell lung cancer patients with interstitial lung disease: a pilot study. Cancer Chemother Pharmacol 2016; 77: 1245-52. – reference: 3. Doyle T, Mullerworth M. Bleeding as a complication of fine needle lung biopsy. Thorax 1988; 43: 1013-4. – reference: 11. Watanabe N, Niho S, Kirita K, Umemura S, Matsumoto S, Yoh K, et al. Vinorelbine and cisplatin in patients with advanced non-small cell lung cancer with interstitial pneumonia. Anticancer Res 2015; 35: 1697-701. |
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| Snippet | 症例は慢性心房細動と特発性間質性肺炎，慢性閉塞性肺疾患の既往を有し，プレドニゾロン及びアピキサバン内服中の81歳，男性．胸部CTで左下葉に1.7 cmの結節を... |
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| Title | 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 |
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