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August 1981

Abdominal Hemorrhage After Perforation of a Diaphragmatic Artery During Thoracentesis

Arch Intern Med. 1981;141(9):1238. doi:10.1001/archinte.1981.00340090134033

To the Editor.  —Abdominal hemorrhage is a rare complication of thoracentesis and usually occurs when abdominal viscera are punctured. A major life-threatening abdominal hemorrhage resulted from perforation of a diaphragmatic artery during thoracentesis.

Report of a Case.  —A 48-year-old heroin addict was admitted for therapy for tricuspid valve endocarditis. Laboratory data showed normal findings from coagulation studies. Because of a large left pleural effusion, a thoracentesis was performed. A 22-gauge needle was inserted in the left midaxillary line at the tenth intercostal space with the patient in the left lateral decubitus position. Four hundred milliliters of serosanguineous fluid was aspirated. Six hours later, the patient collapsed, and he was noted to be hypotensive with a tense and distended abdomen. An emergency laparotomy disclosed a hemoperitoneum and an intact spleen. A point bleeding source on the left infradiaphragmatic surface was actively spurting blood. A bleeding diaphragmatic artery was located and ligated

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