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Almulhem S, Mounla Ali R. A Rare but Life-Threatening Case of Spontaneous Hemopneumothorax in a Young Male. Cureus 2023; 15:e49715. [PMID: 38161860 PMCID: PMC10757502 DOI: 10.7759/cureus.49715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 01/03/2024] Open
Abstract
Spontaneous hemopneumothorax (SHP) is the spontaneous accumulation of both blood and air within the pleural space without any previous medical or trauma history. Despite its rare existence, it is one of the most life-threatening conditions seen in the emergency department. Even though SHP is an uncommon presentation, early recognition and prompt intervention are essential because of its rapidly deteriorating nature leading to respiratory distress and hemodynamic instability. This is a case of a 20-year-old male who presented in the emergency room complaining of sudden chest pain and respiratory distress. After physical examination and radiological investigation, a diagnosis of left-sided spontaneous hemopneumothorax was the top differential that consisted of the patient's presentation and chest X-ray. Subsequently, a chest tube was inserted to drain the blood in the pleural cavity. In addition to the presence of blood in the chest tube, the serum hemoglobin levels of the patient were low, which suggested the diagnosis of hemopneumothorax. After that, the patient underwent video-assisted thoracoscopic surgery (VATS) which demonstrated a significant amount of pleural blood clots, pleural adhesions, and apical blebs in the lung. Through this procedure, the source of the bleeding was found to be a ruptured adhesion in the left lung. By the end of this surgical intervention, the adhesions were cauterized and the blebs were resected. Post-operatively, the patient stabilized and had a full lung expansion upon follow-up. This case emphasizes the importance of early recognition, diagnosis, and prompt surgical management of SPH to prevent life-threatening complications.
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Affiliation(s)
- Shamayel Almulhem
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Rakan Mounla Ali
- Thoracic Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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Chen Y, Guo Z. Unusual case of primary spontaneous hemopneumothorax in a young man with atypical tension pneumothorax: a case report. J Med Case Rep 2018; 12:188. [PMID: 29961427 PMCID: PMC6027734 DOI: 10.1186/s13256-018-1732-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spontaneous life-threatening hemopneumothorax is an atypical but treatable entity of unexpected circulatory collapse in young patients, affecting 0.5-11.6% of patients with primary spontaneous pneumothorax. Spontaneous pneumothorax is a well-documented disorder with a classic clinical presentation of acute onset chest pain and shortness of breath. This disorder might be complicated by the development of hemopneumothorax or tension pneumothorax. CASE PRESENTATION A 23-year-old Asian man was referred to the emergency room of Xiamen Chang Gung Memorial Hospital with a 1-day history of right-sided chest pain that had been aggravated for 1 hour. A physical examination revealed a young man who was awake and alert but in mild to moderate painful distress. His vital parameters were relatively stable at first. The examining physician noted slight tenderness along the right posterolateral chest wall along the eighth and tenth ribs. Primary spontaneous pneumothorax was considered, and a standing chest X-ray confirmed the diagnosis. A right thoracostomy tube was immediately placed under sterile conditions, and he was referred to the respiratory service. While in the respiratory department, approximately 420 mL of blood was drained from the thoracostomy tube over 15 minutes. Our patient developed obvious hemodynamic instability with hypovolemic shock and was subsequently admitted to the cardiothoracic surgical ward after fluid resuscitation. During the ensuing 4 hours after admission, 750 mL of blood was drained through the thoracostomy tube. A bedside chest X-ray was requested after he was temporarily hemodynamically stabilized. Primary spontaneous hemopneumothorax associated with right tension pneumothorax was considered based on the radiological impression and clinical signs. An emergency limited posterolateral thoracotomy was performed. A standing chest X-ray performed on day 6 of admission after the removal of the thoracostomy tube showed a complete re-expansion of his right lung. He remained stable and was discharged within 1 week. CONCLUSIONS The successful treatment of a large spontaneous hemopneumothorax depends on early recognition, proactive intervention, and early consideration by a cardiothoracic surgeon. Once the diagnosis is confirmed, early thoracotomy should be considered. Such an aggressive surgery not only leads to shorter hospitalization but also confers better long-term outcomes.
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Affiliation(s)
- Youwen Chen
- Department of Thoracic Cardiovascular Surgery, Chang Gung Memorial Hospital, 123 Avenue Xiafei, Xiamen, 361028, Fujian, China.
| | - Zhijian Guo
- Department of Thoracic Cardiovascular Surgery, Chang Gung Memorial Hospital, 123 Avenue Xiafei, Xiamen, 361028, Fujian, China
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Lai PF, Tsay PJ, Tsai MJ, Huang TY. X-Ray Quiz: A 27-Year-Old Male with Sudden Dyspnoea. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- PF Lai
- Tzu Chi University, Institutes of Pharmacology and Toxicology, College of Medicine, Hualien, Taiwan
| | - PJ Tsay
- Buddhist Tzu Chi General Hospital, Department of Anesthesiology, Hualien, Taiwan
| | - MJ Tsai
- Tzu Chi University, Institutes of Pharmacology and Toxicology, College of Medicine, Hualien, Taiwan
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Barua A, Brown R, Puppala S, O'Regan DJ. Spontaneous Hemothorax Following Cardiac Surgery. J Card Surg 2016; 31:211-3. [PMID: 26953253 DOI: 10.1111/jocs.12729] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case of spontaneous hemothorax after aortic valve replacement in a 72-year-old female resulting from rupture of a pleural adhesion leading to hemodynamic instability. doi: 10.1111/jocs.12729 (J Card Surg 2016;31:211-213).
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Affiliation(s)
- Anupama Barua
- Department of Cardiac Surgery, Leeds Teaching Hospital NHS Foundation Trust, Leeds, United Kingdom
| | - Robert Brown
- Department of Anaesthesia, Leeds Teaching Hospital NHS Foundation Trust, Leeds, United Kingdom
| | - Swapna Puppala
- Department of Radiology, Leeds Teaching Hospital NHS Foundation Trust, Leeds, United Kingdom
| | - David J O'Regan
- Department of Cardiac Surgery, Leeds Teaching Hospital NHS Foundation Trust, Leeds, United Kingdom
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Inafuku K, Maehara T, Yamamoto T, Masuda M. Assessment of spontaneous hemopneumothorax: Indications for surgery. Asian Cardiovasc Thorac Ann 2015; 23:435-8. [PMID: 25614480 DOI: 10.1177/0218492314568105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although spontaneous hemopneumothorax is rare, emergency surgery may be necessary if massive bleeding is present. METHODS We examined therapeutic strategies and outcomes as well as background factors in 16 patients with spontaneous hemopneumothorax treated at our hospital between April 2002 and August 2013. RESULTS Emergency surgery was performed in 3 patients, all of whom were hemodynamically unstable. Elective surgery was performed in 7 patients, all of whom showed continuous bleeding from a pleural cavity drain. The surgery consisted of intrapleural hematoma removal, hemostasis, and bullectomy; 3-port thoracoscopy was used in all of the surgical cases. Six patients, none of whom showed continuous bleeding, recovered with conservative therapy. Comparing the conservative therapy and surgery groups revealed the mean continuous bleeding volume and total blood loss to be significantly greater in the latter, but no significant difference was noted between the two groups in terms of the initial bleeding volume following tube thoracostomy. None of the cases required a blood transfusion. CONCLUSIONS Spontaneous hemopneumothorax is not necessarily an indication for surgery, and even when the initial volume of blood drained through the chest tube is large, some patients can still be treated conservatively with careful monitoring of vital signs and continuous bleeding volumes. However, it is important not to miss the optimal timing of surgery in order to avoid administering unnecessary blood transfusions to young patients.
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Affiliation(s)
- Kenji Inafuku
- Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Takamitsu Maehara
- Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Taketsugu Yamamoto
- Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Non-traumatic and spontaneous hemothorax in the setting of forensic medical examination: a systematic literature survey. Forensic Sci Int 2013; 236:22-9. [PMID: 24529771 DOI: 10.1016/j.forsciint.2013.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 12/07/2013] [Accepted: 12/15/2013] [Indexed: 01/18/2023]
Abstract
Spontaneous hemothorax is a well-known yet seldom-reported entity in forensic literature. While trauma-related hemothorax is frequently encountered in a medicolegal setting, non-traumatic and spontaneous hemothorax are relatively uncommon entities. The wide range of causes that can trigger fatal intrathoracic bleeding include thoracic aortic dissection, followed by vascular malformations, various oncological diseases, and connective tissue abnormalities. In rare instances, extramedullary hematopoiesis, ectopic pregnancy, congenital heart defects, amyloidosis, or parasitic diseases may constitute a source of bleeding. This etiological heterogeneity may, as a result, cause diagnostic difficulties during post-mortem elucidation of hemothorax. It should be borne in mind that hemothorax after low-energy trauma does not exclusively indicate traumatic hemorrhage, hence, the non-traumatic origin of bleeding must be taken into consideration. In this paper, we present a systematic review of the relevant literature enriched by the results of our observations to investigate the etiologies and recommendations for the post-mortem diagnosis of spontaneous hemothorax in an attempt to better delineate the possible medicolegal considerations. It is important that forensic pathologist as well as clinicians are aware of the diseases that could potentially give rise to fatal hemothorax.
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Onuki T, Goto Y, Kuramochi M, Inagaki M, Sato Y. Spontaneous hemopneumothorax: epidemiological details and clinical features. Surg Today 2013; 44:2022-7. [PMID: 24132683 DOI: 10.1007/s00595-013-0746-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
PURPOSES Spontaneous hemopneumothorax (SHP) may cause life-threatening blood loss. The objective of this study was to elucidate the epidemiological and clinical features of SHP. METHODS We reviewed the records of 26 patients who underwent surgery for SHP between 1989 and 2010. We evaluated their epidemiology and clinical features by comparing them with those of 681 patients with spontaneous pneumothorax treated during the same period. RESULTS The proportion of smokers in the SHP group was higher than that in the spontaneous pneumothorax group (P < 0.01). Seventeen cases (65.4 %) of SHP occurred on the left side. The most frequent bleeding area was the superior thoracic aperture (STA:17 cases, 65.4 %), followed by the left superior mediastinum (six cases, 23.1 %). Ten cases had intrathoracic clots greater than 500 mL, which could not be drained preoperatively. The postoperative stay of patients treated with video-assisted thoracic surgery (VATS) was shorter than that of patients treated with open thoracotomy (21 versus five cases; P < 0.05). CONCLUSIONS A higher proportion of smokers was revealed in the SHP patients. VATS shortened the hospital stay of the patients. The particular areas that should be observed intraoperatively are the STA and the left superior mediastinum.
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Affiliation(s)
- Takuya Onuki
- Department of Thoracic Surgery, Tsuchiura Kyodo General Hospital, 11-7 Manabe-shincho, Tsuchiura, Ibaraki, 300-0053, Japan,
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Moon HJ, Hwang SW. Clinical Experience of Spontaneous Hemopneumothorax. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2010. [DOI: 10.5090/kjtcs.2010.43.6.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hyeon Jong Moon
- Department of Thoracic and Cardiovascular Surgery, SMG-SNU Boramae Medical Center
| | - Seong Wook Hwang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital
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Migliore M, Lombardo G. An unusual clinical case of haemoptysis in spontaneous pneumothorax: blood clots within emphysematous bulla. BMJ Case Rep 2009; 2009:bcr08.2008.0796. [PMID: 21686625 DOI: 10.1136/bcr.08.2008.0796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report an unusual case of spontaneous haemopneumothorax associated with haemoptysis due to blood clots within emphysematous bulla in a 42-year-old man. Haemoptysis disappeared after surgery.
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Affiliation(s)
- Marcello Migliore
- Thoracic Surgery, University of Catania, Department of Surgery, Piazza Università, Catania, 95125, Italy
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Azfar Ali H, Lippmann M, Mundathaje U, Khaleeq G. Spontaneous hemothorax: a comprehensive review. Chest 2008; 134:1056-1065. [PMID: 18988781 DOI: 10.1378/chest.08-0725] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to review the treatment options for spontaneous haemopneumothorax (SHP) by video-assisted thoracoscopic surgery (VATS). METHODS Records from 16 patients (14 male, age 16-38 years, mean age 26.1 years) with prominent SHP (blood loss over 400 cc in the first 24 h) undergoing VATS from July 1994 to December 2005 and treated by one thoracic surgeon in four medical centres or community hospitals of North and Mid-Taiwan were reviewed retrospectively. RESULTS Thirteen patients (81.3%) were identified to have a prominent bleeding source intraoperatively. Torn engorged vessels from the parietal pleura to adjacent bullae were found in nine patients, and bleeders adjacent or over the parietal part of the adhered pleura were found in the other four. Ruptured bullae/blebs or air leakage were found in 14 (87.5%). All underwent removal of intrapleural blood clot, control of bleeders and their bullae/blebs were resected through three-port VATS (n = 13, 81.2%) or mini-thoracotomy and VATS (n = 3, because of unstable vital signs or conversion because of dense adhesion). Mechanical or chemical pleurodesis was carried out in all patients. The mean operative time was 53.8 +/- 21.7 min. There was no postoperative mortality. However, recurrent bleeding requiring reoperation occurred in one patient, and one other patient had a prolonged air leakage (>7 days) postoperatively and recovered spontaneously. The mean duration of chest tube drainage was 3.8 days and the median follow-up period was 3.2 years. CONCLUSION SHP complicated by severe bleeding is a surgical emergency. VATS is a reasonable treatment for patients with SHP.
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Affiliation(s)
- Shi-Ping Luh
- Department of Surgery, Chung-Shan Medical University Hospital, Taichung, Taiwan
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Chang YT, Dai ZK, Kao EL, Chuang HY, Cheng YJ, Chou SH, Huang MF. Early Video-Assisted Thoracic Surgery for Primary Spontaneous Hemopneumothorax. World J Surg 2006; 31:19-25. [PMID: 17180561 DOI: 10.1007/s00268-006-0354-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Primary spontaneous hemopneumothorax (PSHP) is a rare surgical emergency. The aim of this study was to compare the previous strategy of tube thoracostomy followed by thoracotomy when complications developed with early video-assisted thoracic surgery (VATS) for PSHP. METHODS Between November 1989 and May 2005, a total of 24 consecutive patients with PSHP were retrospectively reviewed. Before January 2000, there were 13 patients who were subjected to the treatment strategy of initial tube thoracostomy and underwent operation if the condition deteriorated or later complications occurred (group T). Under this strategy, all of these patients later required operations. After January 2000, another 11 patients were treated with VATS as soon as their condition stabilized after tube thoracostomy and resuscitation (group V). The data for the two groups were compared: sex, age, involved side, initial heart rate (HR) and mean blood pressure (BP), initial hemoglobin (Hb), preoperative blood loss, operating time, amount of blood transfusion, period of chest tube drainage (POD), length of hospital stay (LOS), complications, and length of follow-up. RESULTS The sex, age, involved side, and the initial HR, BP, and Hb of the two groups were similar. The patients of group V had a significantly longer operating time [group V, 111 minutes (mean); group T, 85 minutes, P = 0.002]; less preoperative blood loss (group V, 946 ml; group T, 1687 ml, P = 0.003); less blood transfusion (group V, 465 ml; group T, 1044 ml, P = 0.002); shorter POD (group V, 4 days; group T, 7 days, P = 0.011); and shorter LOS (group V, 5 days; group T, 10 days, P = 0.002). No mortality or recurrence was noted in the entire series. CONCLUSIONS Our study suggests that surgery should be undertaken for PSHP as soon as possible after the clinical condition has stabilized. Under this strategy, VATS is an acceptable approach. It allows a shorter hospital stay and is exempt from unnecessary blood transfusion. Later complications, such as empyema and impaired lung reexpansion, can also be avoided.
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Affiliation(s)
- Yu-Tang Chang
- Department of Surgery, Kaohsiung Medical University Hospital, 100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan
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Hsu NY, Shih CS, Hsu CP, Chen PR. Spontaneous hemopneumothorax revisited: clinical approach and systemic review of the literature. Ann Thorac Surg 2005; 80:1859-63. [PMID: 16242469 DOI: 10.1016/j.athoracsur.2005.04.052] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2005] [Revised: 04/25/2005] [Accepted: 04/26/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spontaneous hemopneumothorax, defined as the accumulation of more than 400 mL of blood in the pleural cavity in association with spontaneous pneumothorax, is a rare entity occurring in young patients and may be life threatening. Although many reports of case studies and series have been published in the world literature, the lack of consistent intraoperative findings and varying surgical methods require a review study. METHODS We discuss the clinical features, management, surgical findings, and outcomes of our own patients with spontaneous hemopneumothorax. RESULTS From September 1997 to September 2003, 488 patients with spontaneous pneumothorax were treated at our hospital. Of these patients, 27 (5.5%) had spontaneous hemopneumothorax develop. These 27 patients were comprised of 25 men and 2 women ranging in age from 15 to 39 years (mean age, 22.3 years). The amount of blood that was drained ranged from 400 to 1,700 mL (mean, 1,012 mL). Twenty-one patients underwent video-assisted thoracoscopic surgery within 1 day after admission; the remaining 6 patients were treated conservatively with tube thoracostomy alone. On arrival at our emergency room, 9 patients (33.3%) experienced hemodynamic instability with hypovolemic shock. In a review of 6,396 patients with spontaneous pneumothorax in the literature and in our current study, 201 patients (3.1%) had spontaneous hemopneumothorax develop. One hundred seventy-six patients (87.6%) were treated surgically, whereas video-assisted thoracoscopic surgery has been performed in 48.9% of patients (86 of 176). There was no recurrence of hemopneumothorax in any of the 201 patients with spontaneous hemopneumothorax after treatment during the follow-up period. CONCLUSIONS Thus one-third of the patients with spontaneous hemopneumothorax had shock symptoms develop. Video-assisted thoracoscopic surgery may be considered as an initial treatment procedure for patients with spontaneous hemopneumothorax, whereas conservative treatment is effective and may be performed in selected patients.
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Affiliation(s)
- Nan-Yung Hsu
- Division of Chest Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan, Republic of China.
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Chiang WC, Chen WJ, Chang KJ, Lai TI, Yuan A. Spontaneous hemopneumothorax: an overlooked life-threatening condition. Am J Emerg Med 2003; 21:343-5. [PMID: 12898496 DOI: 10.1016/s0735-6757(03)00085-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Spontaneous hemopneumothorax is a rare clinical entity. A large spontaneous hemopneumothorax is life-threatening, and mortality increases with delayed recognition and intervention. The initial chest radiography and the amount of blood drained from the inserted chest tube frequently underestimates the actual blood loss from the active bleeder around the ruptured apical bullae, leading to failed recognition of a potentially life-threatening condition until unexpected hemodynamic collapse develops. We report 2 cases of spontaneous hemopneumothorax to emphasize the importance of early recognition and prompt surgical intervention by video-assisted thoracoscopic surgery (VATS).
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Affiliation(s)
- Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei, Taiwan 100.
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Wu YC, Lu MS, Yeh CH, Liu YH, Hsieh MJ, Lu HI, Liu HP. Justifying video-assisted thoracic surgery for spontaneous hemopneumothorax. Chest 2002; 122:1844-7. [PMID: 12426291 DOI: 10.1378/chest.122.5.1844] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES Video-assisted thoracic surgery (VATS) has gained a prominent role in routine thoracic surgery practice. This study discusses the clinical aspects and utility of VATS in spontaneous hemopneumothorax (SHP). PATIENTS Of 363 spontaneous pneumothorax (SP) cases, 24 patients presented with SHP (6.6%). The clinical features, surgical indications, emergency VATS technique, and patient outcomes are discussed. RESULTS All 24 patients were male (mean age, 25.3 years). Eleven patients were in hypovolemic shock, and their hemoglobin levels ranged from 6.7 to 12.7 g/dL; therefore, they received fluid resuscitation and blood transfusion. The amount of blood drained through the chest tube varied from 200 to 3,500 mL. Emergency VATS revealed that 5 cases were simple hemothoraces and 19 cases were associated with pneumothorax. The cause of bleeding was identified by thoracoscopy, as from an aberrant vessel (n = 11), torn parietal pleura (n = 4), ruptured vascularized bullae (n = 2), and lung parenchyma (n = 1). Six patients had no evidence of an obvious bleeding site. Bullous lesions were at the apex of the upper lobe in 14 patients, and multiple lobar involvement was seen in 2 patients. All the bullae were resected with endoscopic stapler in eight patients and ligated with a homemade endoloop in eight patients. The mean operation time was 42 min. The mean chest tube removal time was 3.5 days after insertion, and mean postoperative stay was 4.5 days. There is no recurrence of SHP or SP during the follow-up period. CONCLUSION SHP complicated by severe bleeding presents a potentially grave emergency. VATS may be considered as feasible treatment for patients with SHP.
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Affiliation(s)
- Yi-Cheng Wu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
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