[Chronic hemorrhagic pyothorax treated with preoperative internal thoracic and intercostal arterial embolization and perioperative non-invasive positive pressure ventilation].
We reported successful surgery for chronic hemorrhagic empyema with severe right heart insufficiency. The preoperative embolization of right internal thoracic artery and intercostals arteries was effective for the control of intraoperative bleeding. Non-invasive positive pressure ventilation (NIPPV) was useful for the perioperative respiratory management. A 62-year-old female with a history of right pneumonectomy and thoracoplasty for pulmonary tuberculosis was admitted because of dyspnea on effort on Dec 5th 2002. Her right heart insufficiency was worsened gradually. On May 20th 2003, we performed the transcatheter embolization of right internal thoracic and intercostals arteries for the control of intraoperative bleeding. The next day, the curettage and fenestration was performed for intraoperative cardiac dysfunction. The intraoperative bleeding was 1,596 ml and operative time was 2 hours 24 minutes. Due to CO2 narcosis, the ventilator under the intratracheal tube was needed for respiratory management in the postoperative course. The switching of the respiratory management with NIPPV from the intratracheal tube during 8 days, her respiratory and general conditions had been improved gradually. Because of methicillin-resistant Staphylococcus aureus (MRSA) infection of thoracic cavity, the radical thoracoplasty following the latissimus dorsi muscules flap and the omentopexy was performed. The operative course was uneventful and she needed overnight NIPPV without O2 inhalation and was discharged.
Noriyuki
Toshio
T
Department of Surgery, Yoshijima Hospital, Hiroshima, Japan.
Murai
H
H
Ubagai
T
T
Kimura
A
A
Koga
R
R
Okumichi
T
T
D002908:Chronic Disease; D004621:Embolization, Therapeutic / Q000379:methods; D016724:Empyema, Pleural / Q000628:therapy*; D005260:Female; D006491:Hemothorax / Q000628:therapy*; D006801:Humans; D007385:Intermittent Positive-Pressure Ventilation; D008323:Mammary Arteries; D008875:Middle Aged; D019990:Perioperative Care