SPONTANEOUS HEMOPNEUMOTHORAX IN A HEMOPHILIAC

Life-threatening mediastinal-retroperitoneal hemorrhage in a child with moderate hemophilia A and high inhibitor titer: successful management with recombinant activated factor VII

The authors describe an 11-year-old boy with hemophilia A and high titer inhibitor who developed a life-threatening mediastinal-retroperitoneal hemorrhage. Chest CT showed a large hematoma beginning in the retrotracheal area, filling the mediastinum, compressing the carina, and extending retroperitoneally up to the kidneys. As the surgical approach has a high mortality rate, the authors chose a more conservative approach initially and obtained excellent bleeding control with recombinant activated factor VII without the need for surgical intervention. As reported in other patients, the authors also showed a decrease in the factor III inhibitor while this patient was successfully treated with bypassing agents.

Hemothorax in a child. An unusual cause of chest pain

The pediatrician should search carefully in a child with chest pain for evidence in the history or physical examination of an organic cause. Hemothorax is one of the pathologic processes that can present with this symptom. The differential diagnosis of hemothorax in children is reviewed.

Spontaneous haemothorax in a mild haemophiliac

Spontaneous haemothoraxis is a very rare presenting manifestation in haemophilia, only four previous cases being recorded in the English literature. The clinical features and management of such a case by intercostal tube drainage in a previously unrecognized haemophiliac are described.