In the literature, a hemopneumothorax is defined as an abnormal accumulation of blood (> 400 mL) in the pleural space (between the visceral and parietal layers of the pleura), predominantly as a complication of a pneumothorax (encompassing about 5% of cases) [1] [2] [3] [4]. Various blood vessels located in the proximity of this anatomical landmark are identified as the source of bleeding (vessels in the adhesions between pleural layers are most common, whereas congenital aberrant vessels or a vascularized bulla are also described) and the majority of reports indicated that the cause is predominantly spontaneous, in the absence of trauma or other precipitating events [1] [3] [5] [6] [7]. In rare cases, however, chest trauma might lead to vessel rupture and consequent hemopneumothorax [7]. For as yet unknown reasons, this disorder principally occurs in adolescents, with a stronger predilection towards the male gender [2] [3] [6]. The clinical presentation is comprised of the sudden spontaneous appearance of respiratory complaints, such as dyspnea and chest pain, but up to 30% of individuals suffer from hypovolemic shock, manifesting as hypotension and poor general condition [6] [8]. The importance of an early diagnosis stems from the life-threatening nature of hemopneumothorax, which could also be complicated by infections, an inability of the lung to regain its structure or the persistence of a pneumothorax [6].

• Intravenous Drugs

  This article reports a case of an intravenous drug abuser who presented with a hemopneumothorax, which is a rare complication of jugular vein self-injection. [ncbi.nlm.nih.gov]

• Pleuritic Pain

  Increase in size of the collection, development of an air-fluid level, or the new onset of symptoms (eg, fever, cough, dyspnea, pleuritic pain) may warrant CT evaluation and reassessment for surgical intervention. [healthjade.net]

• Hypotension

  The clinical presentation is comprised of the sudden spontaneous appearance of respiratory complaints, such as dyspnea and chest pain, but up to 30% of individuals suffer from hypovolemic shock, manifesting as hypotension and poor general condition. [symptoma.com]

  I (perhaps mistakenly) thought that VATS procedure would be an contraindication in such a hypotensive patient and it would be more safe to perform an open operation. [ctsnet.org]

  Patients can also obviously represent chest trauma, possibly hypotension and shock. Physical exploration can reveal possible segments of ulcers, subcutaneous emphysema or hematoma. [healthgala.info]

  The nurse is caring for the client who is in skeletal traction for a femoral fracture and notes client assessment data includes dyspnea, hypoxia, petechial rash on chest, and hypotension. Which should the nurse implement? 1. [quizlet.com]

  There were hypotension, tachycardia and tachypnea in patient. Laboratory results as shown in Table 1 were suggestive of acidosis, hypoalbuminemia and elevated urea and creatinine values. [casereports.in]

• Angiomatosis

  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 [ncbi.nlm.nih.gov]

  […] surgical management. ( 25409674 ) Tay CK...Asmat A 2015 18 Assessment of spontaneous hemopneumothorax: Indications for surgery. ( 25614480 ) Inafuku K...Masuda M 2015 19 Pneumothorax-associated fibroblastic lesion in combination with localized pleural angiomatosis [malacards.org]

• Night Sweats

  She also complained of intermittent fevers, dry cough, night sweats, and 30-lb weight loss. Her past medical history included mild intermittent asthma and keloids, which were extensive, disfiguring, and painful. [journals.lww.com]

• Numbness of the Hand

  The patient achieved an inadvertent subclavian arterotomy, causing tingling and numbness in the hand and arm, an unusual "high," and blood filling the pleura, collapsing the lung. [ncbi.nlm.nih.gov]

As hemopneumothorax may be fatal if undiagnosed early, physicians must include this clinical entity in the differential diagnosis of sudden chest pain and shock in otherwise healthy adolescents [3] [8]. Thus, a thorough patient history regarding the course and progression of symptoms (as well as exclusion of preexisting illnesses or events that might point to an underlying cause) and a detailed physical examination, with an emphasis on pulmonary auscultation, are vital steps in raising clinical suspicion [9]. A complete laboratory workup, particularly focused on a complete blood count (CBC), hematocrit levels (both from venous blood and the aspirated blood), and a full coagulation panel, can provide useful clues for confirming the diagnosis [4]. Imaging studies, however, are the gold standard for the diagnosis of hemopneumothorax and should be employed as soon as possible. Plain radiography of the chest and ultrasonography have been shown to be very useful initial methods for evaluation of patients in whom pneumothorax and hemopneumothorax are suspected [9]. Computed tomography (CT), particularly contrast-enhanced, is often used as a definite method for confirming the diagnosis and the underlying process that caused the bleeding (if present) [4] [7] [9].

• Normal Chest X-Ray

  As the patient had a normal chest X-ray 3 days ago, thoracoscopic pleural biopsy was taken which confirmed the diagnosis of an epithelioid mesothelioma. [lungindia.com]

• Kerley A Lines

  CXRs may show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing perihilar pattern, upper lobe diversion (increased blood flow to the superior parts of the lung), and possible pleural effusion. [jmedicalcasereports.biomedcentral.com]

• Kerley B Lines

  CXRs may show fluid in the alveolar walls, Kerley B lines, increased vascular shadowing in a classical batwing perihilar pattern, upper lobe diversion (increased blood flow to the superior parts of the lung), and possible pleural effusion. [jmedicalcasereports.biomedcentral.com]

1. Kim ES, Kang JY, Pyo CH, Jeon EY, Lee WB. 12-year experience of spontaneous hemopneumothorax. Ann Thorac Cardiovasc Surg. 2008 Jun; 14(3):149-53.
2. Hsu NY, Shih CS, Hsu CP, Chen PR. Spontaneous hemopneumothorax revisited: clinical approach and systemic review of the literature. Ann Thorac Surg. 2005;80(5):1859-1863.
3. Issaivanan M, Baranwal P, Abrol S, Bajwa G, Baldauf M, Shukla M. Spontaneous hemopneumothorax in children: case report and review of literature. Pediatrics. 2006;118(4):e1268-1270.
4. Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR. Etiology and management of spontaneous haemothorax. J Thorac Dis. 2015;7(3):520-526.
5. Bhaskar J, Sharma AK. Spontaneous Hemo-pneumothorax as a Result of Venous Hemangioma: A Unique Case? Tex Heart Inst J. 2006;33(1):91-92.
6. Chong K, Qureshi SA, Badea G, Lok S. Spontaneous haemopneumothorax. BMJ Case Rep. 2011;2011:bcr0420114065.
7. Fagkrezos D, Giannila M, Maniatis P, Papailiou J, Triantopoulou C. Post-traumatic pulmonary pseudocyst with hemopneumothorax following blunt chest trauma: a case report. Journal of Medical Case Reports. 2012;6:356.
8. Hart SR, Willis C, Thorn A, et al. Spontaneous haemopneumothorax: are guidelines overdue? Emerg Med J 2002;19:273–274.
9. Kakaris S, Athanassiadi K, Vassilikos K, Skottis I. Spontaneous hemopneumothorax: a rare but life-threatening entity. Eur J Cardiothorac Surg. 2004;25(5):856-858.