高齢者に発症した外傷性胸膜外血腫

Successful Surgical Treatment for Traumatic Extrapleural Hematoma in an Elderly Patient

日常臨床において胸膜外血腫（extrapleural hematoma：EPH）は血胸と比べて遭遇する頻度が低く，あまり知られていない．われわれは高齢者のEPHに対して手術を行い，良好な経過を得た1例を経験したので報告する．

An 82-year-old man receiving anticoagulants was referred to our hospital with dyspnea and back pain. One day earlier, he bruised his back in his house. On arrival, the hemoglobin value was 5.6 g/dl, and computed tomography （CT） showed bilateral pleural effusion along with left lower rib fractures. In the left hemithorax, irregular high-density lesion which was surrounded by a low-density stripe was observed. He was initially diagnosed with left traumatic hemothorax, and managed through inpatient care with bed rest and blood transfusion. Although anemia was improved, bilateral compression atelectasis was observed compromising cardiopulmonary function. We therefore performed surgical treatment on the 14th hospital day. Under general anesthesia, a chest tube was inserted into the right thoracic cavity, removing 1,000 ml of serous pleural effusion. We subsequently performed a left-sided thoracotomy. After suctioning 400 ml of bloody pleural effusion, we found a pleural bulge in the posterior chest wall. Hematoma was accumulated in the extrapleural space. The parietal pleura was opened and the extrapleural hematoma was bluntly curetted and evacuated. The deviated rib fracture was repaired. Postoperative course was uneventful. He was discharged home after rehabilitation on postoperative day 54.