[右上叶肺动脉栓塞是复发性自发性气胸的罕见病因]。

Q4 Medicine Khirurgiya Pub Date : 2024-01-01 DOI:10.17116/hirurgia2024011102
G M Agafonov, A S Petrov, M A Atyukov, O V Novikova, I Yu Zemtsova, I V Dvorakovskaya, P K Yablonsky
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引用次数: 0

摘要

一名 19 岁的患者一年前曾接受过右上肺叶楔形切除术,后因反复出现右侧自发性气胸而急诊入院。根据自发性气胸的标准治疗方法,我们进行了诊断性胸腔镜检查和右侧胸膜腔引流术,并定期进行 X 光检查。然而,这些措施都没有效果。患者被安排接受手术治疗,我们在术中观察到了气胸的异常原因。因此,我们介绍了右上叶肺栓塞后的自发性气胸。本病例的独特性与罕见病变的不寻常表现和非标准定位有关。世界文献中描述了几例类似患者的气胸病例。诊断此类缺陷(识别供应异常肺实质的异常血管)的关键限制因素是缺乏对气胸患者进行常规 CT 血管造影检查。这就是为什么 CT 变化被解释为术后变化,而真正的原因只有在重新手术时才能确定。对胸膜腔的彻底检查以及对右上肺叶异常外观的警觉使我们有可能提出非标准诊断,避免并发症(传入血管出血)并进行适当的肺部切除。
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[Right upper lobe pulmonary sequestration as a rare cause of recurrent spontaneous pneumothorax].

A 19-year-old patient after previous wedge resection of the right upper pulmonary lobe a year ago urgently admitted with recurrent right-sided spontaneous pneumothorax. According to standard management of spontaneous pneumothorax, we performed diagnostic thoracoscopy and drainage of the right pleural cavity with regular X-ray examinations. However, these measures were ineffective. The patient was scheduled for surgery, and we intraoperatively observed an unusual cause of pneumothorax. Thus, we present spontaneous pneumothorax following right upper lobe pulmonary sequestration. The uniqueness of this case is associated with unusual manifestation and non-standard localization of rare lesion. A few cases of pneumothorax in similar patients are described in the world literature. The key limiting factor in diagnosis of such defects (identification of aberrant vessel supplying abnormal lung parenchyma) is the lack of routine CT angiography in patients diagnosed with pneumothorax. That is why CT changes were interpreted as postoperative ones, and the true cause was established only during redo surgery. A thorough inspection of the pleural cavity and alertness regarding unusual appearance of the right upper pulmonary lobe made it possible to suggest a non-standard diagnosis, avoid complications (bleeding from afferent vessel) and perform adequate lung resection.

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来源期刊
Khirurgiya
Khirurgiya Medicine-Medicine (all)
CiteScore
0.70
自引率
0.00%
发文量
161
期刊介绍: Хирургия отдельных областей сердце, сосуды легкие пищевод молочная железа желудок и двенадцатиперстная кишка кишечник желчевыводящие пути печень
期刊最新文献
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