title: Acute respiratory failure due to hemothorax after posterior correction surgery for adolescent idiopathic scoliosis: a case report.
abstract: BACKGROUND
  Although posterior correction and fusion surgery using pedicle screws carries the risk of vascular injury, a massive postoperative hemothorax in a patient with adolescent idiopathic scoliosis (AIS) is quite rare. We here report a case of a 12-year-old girl with AIS who developed a massive postoperative hemothorax.
  
  
  METHODS
  The patient had a double thoracic curve with Cobb angles of 63° at T2-7 and 54° at T7-12. Posterior correction and fusion surgery was performed using a segmental pedicle screw construct placed between T2 and T12. Although the patient's respiration was stable during the surgery, 20 minutes after removing the trachea tube, the patient's pulse oximetry oxygen saturation suddenly decreased to 80%. A contrast CT scan showed a massive left hemothorax, and a drainage tube was quickly inserted into the chest. The patient was re-intubated and a positive end-expiratory pressure of 5 cmH(2)O applied, which successfully stopped the bleeding. The patient was extubated 4 days after surgery without incident. Based on contrast CT scans, it was suspected that the hemothorax was caused by damage to the intercostal arteries or branches during pedicle probing on the concave side of the upper thoracic curve. Extensive post-surgical blood tests, echograms, and CT and MRI radiographs did not detect coagulopathy, pulmonary or vascular malformation, or any other possible causative factors.
  
  
  CONCLUSIONS
  This case underscores the potential risk of massive hemothorax related to thoracic pedicle screw placement, and illustrates that for this serious complication, respiratory management with positive airway pressure, along with a chest drainage tube, can be an effective treatment option.
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Ogura
authors.forename: Kota
authors.initials: K
authors.lastname: Watanabe
authors.forename: Naobumi
authors.initials: N
authors.lastname: Hosogane
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Toyama
authors.forename: Morio
authors.initials: M
authors.lastname: Matsumoto
mesh_terms: D000208:Acute Disease; D002648:Child; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D011859:Radiography; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome