Intrapleural Fibrinolytic Therapy for Complex Haemothorax in a Patient with Congenital Heart Disease and Eisenmenger Syndrome: A Case Report
Haemothorax, characterised by blood in the pleural cavity with a haematocrit greater than 50%, can arise from both traumatic and non traumatic causes. Prompt blood removal is crucial to prevent coagulation and complications like post-traumatic empyema. While tube thoracostomy is the initial manageme...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
JCDR Research and Publications Private Limited
2024-11-01
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| Series: | Journal of Clinical and Diagnostic Research |
| Subjects: | |
| Online Access: | https://www.jcdr.net/articles/PDF/20313/74457_CE[Ra1]_F(SHU)_QC(PS_IS)_PF1(RI_SS)_redo_PFA(IS)_PN(IS).pdf |
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| Summary: | Haemothorax, characterised by blood in the pleural cavity with a haematocrit greater than 50%, can arise from both traumatic and non traumatic causes. Prompt blood removal is crucial to prevent coagulation and complications like post-traumatic empyema. While tube thoracostomy is the initial management, Intrapleural Fibrinolytic Therapy (IPFT) offers a less invasive alternative when drainage is insufficient. The authors hereby, report the case of a 33-year-old male with congenital heart disease who presented with haemothorax. He exhibited worsening breathlessness, a cough with yellowish sputum and intermittent fever. Examination revealed clubbing, tachycardia, hypotension, tachypnoea and hypoxia. Imaging confirmed a right-sided pleural effusion with septations and severe Pulmonary Arterial Hypertension (PAH). Initial management with a pigtail catheter and antibiotics resulted in minimal drainage. The patient then underwent IPFT, leading to significant fluid drainage and radiological improvement. His clinical condition improved with reduced breathlessness and stabilised vital signs. The present case supports the efficacy of fibrinolytic agents like Streptokinase (STK) in managing clotted haemothorax, particularly in patients with complex medical backgrounds such as congenital heart disease. Early IPFT can enhance pleural drainage and reduce the need for invasive surgery, highlighting its value in similar clinical scenarios.
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| ISSN: | 2249-782X 0973-709X |