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Salahuddin M, Ayub S. Spontaneous large volume hemothorax managed with a small-bore chest tube. Monaldi Arch Chest Dis 2023; 93. [PMID: 36786166 DOI: 10.4081/monaldi.2023.2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
A 67-year-old male with metastatic lung cancer presented with acute shortness of breath and increasing oxygen requirements. He had a decreasing hemoglobin for which he required red blood cell transfusions. His chest X-ray showed near complete white-out of the left lung. Bedside ultrasound (Handheld Sonostar C4PL) showed a large pleural effusion with swirling echogenic material suggestive of plankton sign. The pleural effusion was aspirated and showed frank blood, after which a small-bore chest tube (SBCT) was inserted. A total of 3200 mL of blood was drained with the SBCT. There was complete clearance of the pleural space, and no further blood product transfusions were needed. This case highlights that conservative management can be considered in patients with spontaneous hemothorax due to metastatic disease.
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Affiliation(s)
| | - Samia Ayub
- Department of Medicine, Aga Khan University, Karachi.
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Tang X, Zhu J, Zhu F, Tu H, Deng A, Lu J, Yang M, Dai L, Huang K, Zhang L. Case Report: Primary Pulmonary Angiosarcoma With Brain Metastasis. Front Bioeng Biotechnol 2022; 9:803868. [PMID: 35071212 PMCID: PMC8776831 DOI: 10.3389/fbioe.2021.803868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/13/2021] [Indexed: 11/21/2022] Open
Abstract
Primary pulmonary angiosarcoma (PPA) is a rare malignant vascular tumor, of which early diagnosis is challenging due to lack of specific clinical manifestations and a low level of suspicion. Here, we report a case of PPA presented with advanced brain metastasis. A 21-year-old patient with 1 week history of headache and mild cough was hospitalized for a head injury. Head MRI showed multiple intracranial lesions with brain edema. Chest CT displayed bilateral pulmonary infiltrates with mediastinal lymph node enlargement. After 2 months of anti-tuberculosis treatment, the patient was readmitted for persistent headache and cough with occasional hemosputum along with worsening pulmonary and intracranial lesions. Despite seizure prophylaxis and control of intracranial pressure and brain edema, his symptoms progressively aggravated, accompanied by cough with bloody sputum, frequent epileptic seizures, and hypotension. He eventually developed coma and died within 3 months of onset of symptoms. An autopsy confirmed PPA with brain metastasis.
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Affiliation(s)
- Xiangjun Tang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Jing Zhu
- Department of Respiratory and Critical Care Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fangcheng Zhu
- School of Basic Medical Sciences, Hubei University of Medicine, Shiyan, China
| | - Hanjun Tu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Aiping Deng
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Junti Lu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Minghuan Yang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Longjun Dai
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Kuanming Huang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Li Zhang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
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Ren Y, Zhu M, Liu Y, Diao X, Zhang Y. Primary pulmonary angiosarcoma: Three case reports and literature review. Thorac Cancer 2016; 7:607-613. [PMID: 27766785 PMCID: PMC5193014 DOI: 10.1111/1759-7714.12376] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/23/2016] [Indexed: 11/30/2022] Open
Abstract
Primary pulmonary angiosarcoma is a rare type of malignant vascular tumor with a very aggressive clinical course and a grim prognosis. To date, only a handful of cases have been reported in English literature. Its rarity and consequent low index of suspicion makes clinical diagnosis difficult. In this report we present three cases of primary pulmonary angiosarcoma with cough, hemoptysis, and progressive dyspnea to contribute to the sparse literature on this disease. A review is made of previous reports of primary pulmonary angiosarcomas, and the clinical characteristics, diagnosed method, treatment options, and prognosis of pulmonary angiosarcoma are also discussed.
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Affiliation(s)
- Yanhong Ren
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China
| | - Min Zhu
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan Liu
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiaoli Diao
- Department of Respiratory Medicine, Capital Medical University, Beijing, China
| | - Yuhui Zhang
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing, China.,Department of Pulmonary and Critical Care Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Abstract
We describe a rare case of primary pulmonary epithelioid angiosarcoma detected by F-FDG PET/CT. A 54-year-old female patient with history of non-Hodgkin lymphoma underwent F-FDG PET/CT for follow-up. PET/CT detected an area of increased F-FDG uptake corresponding to a 4-cm mass located in the inferior lobe of the left lung. Based on this PET/CT finding, the patient underwent left inferior pulmonary lobectomy. Histology demonstrated the presence of a pulmonary epithelioid angiosarcoma. Other sites of disease were excluded. In our case, F-FDG PET/CT has been useful in detecting and staging this rare primary pulmonary tumor.
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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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Yang CF, Chen TW, Tseng GC, Chiang IP. Primary pulmonary epithelioid angiosarcoma presenting as a solitary pulmonary nodule on image. Pathol Int 2012; 62:424-8. [PMID: 22612512 DOI: 10.1111/j.1440-1827.2012.02809.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chun-Fan Yang
- Department of Pathology, China Medical University Hospital, Taichung, Taiwan
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Krenke R, Klimiuk J, Korczynski P, Kupis W, Szolkowska M, Chazan R. Hemoptysis and Spontaneous Hemothorax in a Patient With Multifocal Nodular Lung Lesions. Chest 2011; 140:245-251. [PMID: 21729897 DOI: 10.1378/chest.10-1865] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Rafal Krenke
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland.
| | - Joanna Klimiuk
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland
| | - Piotr Korczynski
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland
| | - Wlodzimierz Kupis
- Department of Surgery, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Malgorzata Szolkowska
- Department of Pathology, National Research Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Ryszarda Chazan
- Department of Internal Medicine, Pneumonology, and Allergology, Medical University of Warsaw, Poland
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Chen YB, Guo LC, Yang L, Feng W, Zhang XQ, Ling CH, Ji C, Huang JA. Angiosarcoma of the lung: 2 cases report and literature reviewed. Lung Cancer 2010; 70:352-6. [DOI: 10.1016/j.lungcan.2010.09.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/02/2010] [Accepted: 09/06/2010] [Indexed: 01/18/2023]
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Weissferdt A, Moran CA. Primary vascular tumors of the lungs: a review. Ann Diagn Pathol 2010; 14:296-308. [PMID: 20637438 DOI: 10.1016/j.anndiagpath.2010.03.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 03/05/2010] [Indexed: 01/16/2023]
Abstract
Unlike their counterparts in other organ systems, primary vascular neoplasms of the lung are rare. Most of these lesions have only been reported as isolated case studies or small series. When dealing with malignant lesions, metastasis from extrapulmonary sites will have to be excluded before a primary location in the lungs can be confirmed. In this review, the clinicopathologic, immunophenotypical, ultrastructural, and molecular biologic characteristics of primary vascular tumors of the lungs are discussed. The tumoral conditions that will be addressed include hemangioma, lymphangioma, epithelioid hemangioendothelioma, angiosarcoma, and Kaposi's sarcoma. Their respective differential diagnoses will also be discussed.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology and Laboratory Medicine, MD Anderson Cancer Center, Houston, TX 77030, USA.
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