胸椎破裂骨折に起因する胸膜外血腫

Extrapleural Hematoma Caused by Thoracic Vertebral Burst Fracture

胸膜外血腫はまれな疾患である．われわれは，胸椎破裂骨折を契機とした胸膜外血腫により肺高血圧，低酸素血症をきたした症例に対して手術を施行し，良好な経過を得たので報告する．

Extrapleural hematoma caused by thoracic vertebral burst fracture is very rare. We present the case of a 70-year-old man who was treated with a combination of video-assisted thoracic surgery （VATS） and extrathoracic operation. The patient was admitted to our hospital with complaints of dyspnea and pain in both legs. Computed tomography （CT） demonstrated a massive extrapleural hematoma in the right thoracic cavity, and 12th thoracic vertebral burst fracture. We treated the patient with pharmacotherapy because CT showed no active bleeding and the circulation and respiratory dynamics were stable. One week later, the hematoma was not reduced by pharmacotherapy, so we performed combination surgery of VATS. After surgery, there were no serious complications and the patient was discharged from the hospital on day 11 from surgery. In the following 2 months, there was no evidence of recurrence. The combination of VATS and extrathoracic operation was safe, and good result was obtained.