Thoracic Active Bleeding: Significance of Contrast Material Extravasation Demonstrated on Computed Tomography

胸腔活動性出血：在電腦斷層以對比劑外漏爲表現的重要性

陳建誠(Chien-Cheng Chen) ； 王俐人(Li-Jen Wang) ； 黃耀祥(Yon-Cheong Wong) ； 陳煥武(Huan-Wu Chen) ； 吳政賢(Cheng-Hsien Wu) ； 方禎鋒(Jen-Feng Fang) ； 林炳川(Being-Chuan Lin) ； 洪聖哲(Sheng-Che Hung)

《中華放射線醫學雜誌》 35卷2期 (2010/06) Pp. 81-88

摘要

Contrast Material extravasation (CME) is a well-documented Radiological Sign of Active bleeding. The purpose of this study is to retrospectively investigate thoracic CME and its relations with surgical intervention and outcome.
Searching the database of the radiology information system (RIS) between 1998 and 2009, we identified 34 patients with CT images of thoracic CME. The CT and medical records were reviewed for the location of CME, cause of CME, time from arrival to CT, time from CT to intervention, time from arrival to intervention, systolic blood pressure, heart rate, international normalized ratio (INR), platelet count, arterial blood gas analysis, the mode of intervention, and final outcome.
Thoracic CME was more frequent in men than in women (n=26 vs. n=8) and in trauma patients than in non-trauma patients (n=25 vs. n=9). The number of patients requiring surgical intervention was greater than that of those not requiring intervention (n=23 vs. n=11). The active bleeder was identified intraoperatively in all cases (100%) underwent surgery. A significant relation was noted between traumatic causes of thoracic hemorrhage and 3 variables-younger age (p＜0.001), lower systolic blood pressure (p=0.007), prolonged prothrombin time (higher INR) (p＜0.001). Prolonged INR and lower platelet count were more significantly associated with CME into the thoracic cavity than with CME into the mediastinum (p=0.005). Blood acidosis was significantly associated with mortality (p=0.005). Despite emergent surgical intervention the mortality rate was still high, at 34.8%.
This study verified CME on chest CT is a sign of thoracic hemorrhage, irrespective of the cause, trauma or non-trauma, is an indicator for the need of surgical intervention, especially in cases of CME into the thoracic cavity. The mortality can still be high in patients with acidosis despite early intervention.

並列摘要

Contrast Material extravasation (CME) is a well-documented Radiological Sign of Active bleeding. The purpose of this study is to retrospectively investigate thoracic CME and its relations with surgical intervention and outcome.
Searching the database of the radiology information system (RIS) between 1998 and 2009, we identified 34 patients with CT images of thoracic CME. The CT and medical records were reviewed for the location of CME, cause of CME, time from arrival to CT, time from CT to intervention, time from arrival to intervention, systolic blood pressure, heart rate, international normalized ratio (INR), platelet count, arterial blood gas analysis, the mode of intervention, and final outcome.
Thoracic CME was more frequent in men than in women (n=26 vs. n=8) and in trauma patients than in non-trauma patients (n=25 vs. n=9). The number of patients requiring surgical intervention was greater than that of those not requiring intervention (n=23 vs. n=11). The active bleeder was identified intraoperatively in all cases (100%) underwent surgery. A significant relation was noted between traumatic causes of thoracic hemorrhage and 3 variables-younger age (p＜0.001), lower systolic blood pressure (p=0.007), prolonged prothrombin time (higher INR) (p＜0.001). Prolonged INR and lower platelet count were more significantly associated with CME into the thoracic cavity than with CME into the mediastinum (p=0.005). Blood acidosis was significantly associated with mortality (p=0.005). Despite emergent surgical intervention the mortality rate was still high, at 34.8%.
This study verified CME on chest CT is a sign of thoracic hemorrhage, irrespective of the cause, trauma or non-trauma, is an indicator for the need of surgical intervention, especially in cases of CME into the thoracic cavity. The mortality can still be high in patients with acidosis despite early intervention.