Aberrant artery as a source of bleeding in spontaneous hemopneumothorax

Massive Spontaneous Haemopneumothorax and Ecstasy Abuse

A 33-year-old man developed spontaneous haemopneumothorax after taking ecstasy in a ‘rave party’. Massive haemorrhage occurred after chest drainage and decompression. Both the adverse effects of ecstasy and risk behaviours at the party might have contributed to the development of the spontaneous haemopneumothorax.

Pneumothorax-associated fibroblastic lesion in combination with localized pleural angiomatosis: A possible cause of juvenile spontaneous hemopneumothorax

Spontaneous hemopneumothorax is an uncommon but potentially life-threatening condition, with a potential for a rapid ventilatory collapse and a large collection of hidden blood loss into the pleural cavity. Here, we report the first case in the literature on pneumothorax-associated fibroblastic lesion in combination with localized pleural angiomatosis in a 19-year-old Caucasian male, resulting in massive spontaneous hemopneumothorax and hypovolemic shock. Our findings support a causal link between this condition and pneumothorax. The possible superimposed hemothorax is explainable by the pleural involvement of large angiomatous vessels, prone to rupture.

Spontaneous hemopneumothorax: Our experience with surgical management

Background

Spontaneous hemopneumothorax is rare, accounting for only 1%–12% of patients presenting with spontaneous pneumothorax. The optimal management of these patients remains controversial with no definitive guidelines on patient selection and timing of surgery. The aim of this study was to review our institution’s surgical experience in the management of patients with spontaneous hemopneumothorax.

Methods

We performed a retrospective review of all patients with spontaneous hemopneumothorax who underwent surgery from January 2000 to June 2013. Patient data were obtained from our institution’s primary spontaneous pneumothorax database.

Results

Of 510 patients who underwent surgery for spontaneous pneumothorax, 33 (6.4%) developed spontaneous hemopneumothorax. The mean age was 24.0 years (range 16–40 years). In 30 (90.9%) patients, it was their first presentation of pneumothorax. There were 25 (75.8%) patients with Vanderschueren stage III spontaneous pneumothorax. Blood loss ranged from 250 to 3000 mL (mean 1280 mL). In 28 patients, a torn adhesion band was the source of bleeding. Thoracotomy was the surgical approach in 9 (27.3%) patients, and video-assisted thoracic surgery was used in 24 (72.7%). One patient required reoperation for retained clots. There was no mortality.

Conclusion

Our results suggest that surgical management of spontaneous hemopneumothorax can be undertaken with minimal morbidity and mortality. With the increasing use of video-assisted thoracic surgery, definitive surgical management of spontaneous hemopneumothorax can be instituted earlier.

Non-traumatic and spontaneous hemothorax in the setting of forensic medical examination: a systematic literature survey

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.

Early Video-Assisted Thoracic Surgery for Primary Spontaneous Hemopneumothorax

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.

Spontaneous hemopneumothorax

PURPOSE OF REVIEW

Spontaneous hemopneumothorax can be life threatening, and is a cause of patients presenting with unexplained signs of significant hypovolemia. The debate relating to patient selection and timing of surgery in patients with spontaneous hemopneumothorax remains unresolved.

RECENT FINDINGS

Our experience together with the latest series published over the last decade on the conservative and surgical management of spontaneous hemopneumothorax are presented and discussed.

SUMMARY

Surgery should be performed early in the management of spontaneous hemopneumothorax to reduce morbidity. In particular, video-assisted thoracic surgery, which is associated with potentially fewer post-operative complications and shorter hospital stays compared with thoracotomy, should be considered in patients with spontaneous hemopneumothorax who are hemodynamically stable.