A hemopneumothorax is a rare, but potentially life-threatening disorder in which bleeding into the pleural space occurs after the development of a pneumothorax. It may be either spontaneous or trauma-induced, and up to a third of patients present with symptoms of shock, in addition to respiratory difficulties such as dyspnea. The diagnosis must be made as soon as possible through imaging studies, including plain radiography, computed tomography, or ultrasonography.
Presentation
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].
Entire Body System
- Pallor
Case Report A 22-year-old male, non-smoker, referred to emergency department for having sudden onset left side chest pain, radiated to the shoulder associated with cough, pallor and generalized body weakness for one day duration. [edoriumjournalofctvs.com]
On admission, the patient presented with hypotension, tachycardia, and cutaneous pallor. Chest X-ray showed hydropneumothorax on the left hemithorax; then, chest tube was placed with an initial drainage of 2000 ml of blood. 1. [hindawi.com]
[…] blood count used to determine inflammation and tissue destruction sepsis - a very severe infection serum amylase enzyme test - a test for pancreatitis shock - a circulatory disturbance marked by a severe drop in blood pressure, rapid pulse, clammy skin, pallor [ruf.rice.edu]
Already in the examination of patients with hilotoraksom Note the significantly reduced body weight, marked pallor and dry skin, sometimes - Crocq's disease, signs of dehydration. [textarchive.ru]
- Turkish
Deutsch (German) العربية (Arabic) Français (French) Русский (Russian) ಕನ್ನಡ (Kannada) 한국어 (Korean) עברית (Hebrew) Український (Ukrainian) اردو (Urdu) Magyar (Hungarian) मानक हिन्दी (Hindi) Indonesia (Indonesian) Italiano (Italian) தமிழ் (Tamil) Türkçe (Turkish [definitions.net]
Russian Swedish Turkish Ukrainian Chinese Ukrainian These examples may contain rude words based on your search. [context.reverso.net]
Respiratoric
- Tachypnea
History and physical results of hemopneumothorax are similar to hemothorax, including dyspnoea, tachypnea and tachycardia. Patients can also obviously represent chest trauma, possibly hypotension and shock. [healthgala.info]
Tachypnea d. Fever e. Hemoptysis a. Chest pain b. Tachycardia c. Tachypnea d. Fever e. Hemoptysis An individual with PE usually presents with the sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety. [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]
However, 2 h after the drainage, tachypnea and shock vitals (blood pressure: 78/60 mmHg, heart rate: 120/min) were identified. Repeated chest X-ray revealed an increase in the amount of right pleural fluid. [academic.oup.com]
A large enough collection of blood causes the patient to experience dyspnea and may produce the clinical finding of tachypnea. [emedicine.medscape.com]
- 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]
Gastrointestinal
- Vomiting
He denied associated nausea, vomiting, dyspnea, fevers, chills, cough, recent illness, or similar past episodes and was able to tolerate oral food and fluids without difficulty prior to arrival. [westjem.com]
Gastrointestinal: abdominal pain, nausea, vomiting, diarrhea, intestinal paresis. 56. Therapy 1. Adrenaline 0.3-0.5 mg / in, if you can not dovenno doing the first dose / m, if necessary repeated administration. [slideshare.net]
He said that on being admitted to hospital, because of the terrible pain, he began to vomit. [saflii.org]
[…] supply to the legs coag panel - a blood test used to determine the clotting factors of a patient's blood code brown - term used when a patient doesn't make it to the bathroom in time compazine - a drug (prochlorperazine) prescribed for severe nausea and vomiting [ruf.rice.edu]
Cardiovascular
- 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]
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]
When accompanied by hypotension, hemorrhagic shock, secondary to bleeding into the thoracic cavity, should be suspected. [journal.chestnet.org]
Major complications are pneumothorax (3-30%), hemopneumothorax, hemorrhage, hypotension (low blood pressure due to a vasovagal response) and reexpansion pulmonary edema. [context.reverso.net]
The reduction in venous return will reduce the preload of the left ventricle, leading to a decrease in cardiac output and consequential poor perfusion and hypotension. [emsworld.com]
Skin
- Sweating
RESULTS: The amount of bleeding ranged from 600 to 1,600 mL, and 3 patients exhibited symptoms of shock, such as sweating, nausea, and syncope. [ncbi.nlm.nih.gov]
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]
"Small" signs of shock pale skin, pale conjunctiva cold clammy sweat dry mouth, thirsty symptom of "white spots" - more than 2 seconds. decrease in urine output - less than 30 ml / h. 34. Decrease in hemoglobin, hematocrit, red blood cells in the peripheral [slideshare.net]
[…] an artery angina pectoris - a severe acute attack of cardiac pain angioplasty - plastic surgery of blood vessels during which a balloon is passed into the artery and inflated to enlarge it and increase blood flow anhidrosis - the abnormal absence of sweat [ruf.rice.edu]
- Ulcer
Physical exploration can reveal possible segments of ulcers, subcutaneous emphysema or hematoma. Lung exudation reveals reduced or absent breathing sounds of affected lungs and hyperresonance on percussion. [healthgala.info]
This concoction is often given to patients presenting with severe heartburn, signs of an ulcer, or indications of an excess production of stomach acid giardiasis - intestinal infection with the giardia bacteria Glasgow coma scale - this scale is used [ruf.rice.edu]
Prolonged vasospasm also leads to tissue damage - stomach ulcers, hemorrhagic enteritis, renal failure. 28. Hospital hemorrhagic shock 29. Clinic shock to a large extent depends on the reasons that cause shock and localization of injury. [slideshare.net]
Multiple distinct ulcers of the lungs D. Spadinnya lungs 13. In the presence of large numbers of pus in the pleural cavity (acute empyema) mezhystinnya shifts: A. In the healthy side * B. As a side injury C. Not shifted D. In any 14. [textarchive.ru]
Neurologic
- Agitation
Psycho-Neurological: agitation, fear of death, in severe cases, convulsions, coma. [slideshare.net]
[…] astrocytoma - a slowly growing tumor of the glial tissue of the brain and the spinal cord asystole - a condition in which the heart no longer beats and usually cannot be restarted ativan - a minor tranquilizer drug (lorazepam) used for anxiety, tension, agitation [ruf.rice.edu]
Workup
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].
Treatment
MT + VATS is an easy accessible and safe procedure that could be applied as an initial treatment method in the patient with spontaneous hemopneumothorax, especially in the treatment of the patients with active hemorrhage and massive blood clot in the [ncbi.nlm.nih.gov]
Spontaneous hemopneumothorax--results of conservative treatment. [archive-ouverte.unige.ch]
Prognosis
Hemopneumothorax developing soon after metastasis to the lung indicates on unfavorable prognosis. [ncbi.nlm.nih.gov]
Early identification and intervention are key for patient prognosis. REFERENCE #1: Hsu NY, Shih CS, Hsu CP, Chen PR. Spontaneous hemopneumothorax revisited: clinical approach and systemic review of the literature. [journal.chestnet.org]
The symptoms, clinical forms, differential diagnosis, course, prognosis and therapy of spontaneous hemopneumothorax are discussed in chapters 4, 5, 7 and 8. [jamanetwork.com]
[edit] The prognosis following a hemothorax depends on its size, the treatment given, and the underlying cause. [en.wikipedia.org]
Spontaneous cases of hemopneumothorax have an excellent prognosis once the fluid and air is removed from the chest. [healthline.com]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
Keywords Adult — Chest Tubes — Drainage — Female — Hemopneumothorax/etiology/therapy — Humans — Male — Recurrence — Thoracotomy — Treatment Outcome Identifiers PMID: 10786105 Full text Article (Published version) (1.5 MB) - Limited access to UNIGE Structures [archive-ouverte.unige.ch]
Although patients with chest trauma are often encountered with hemothorax, the simultaneous rupture of RV wall and pericardium is a rare etiology. [onlinejcf.com]
Although many theories about the pathogenesis were suggested, the etiology of this syndrome remains obscure. [minervamedica.it]
The etiology remains relatively obscure, in the same way that the cause of “essential hematuria” or certain cases of gastrointestinal bleeding remains obscure, even in the presence of exhaustive pathological studies (6, 7). [pubs.rsna.org]
Epidemiology
We evaluated their epidemiology and clinical features by comparing them with those of 681 patients with spontaneous pneumothorax treated during the same period. [ncbi.nlm.nih.gov]
Epidemiology Approximately 5% of patients with pneumothorax will have concomitant hemothorax 6. [radiopaedia.org]
Epidemiology. Approximately 5% of patients with pneumothorax will have concomitant hemothorax 6.. Pathology. [najdi.si]
Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Irfan Dotani Synonyms and Keywords: Hematothorax; haemothorax Overview Historical Perspective Classification Pathophysiology Causes Differentiating Hemothorax from other Diseases Epidemiology [wikidoc.org]
[…] angiomatosis: A possible cause of juvenile spontaneous hemopneumothorax. ( 25749626 ) Roncati L...Maiorana A 2015 20 Spontaneous hemopneumothorax simulating acute abdominal affections. ( 23169600 ) Chen TH...Lin TJ 2014 21 Spontaneous hemopneumothorax: epidemiological [malacards.org]
Pathophysiology
Also discussed will be assessment and treatment problems relating to the pathophysiology of these injuries. [emsworld.com]
Pathophysiology Endometriosis can attach to the lung, forming chocolate-like cysts. [answers.yahoo.com]
Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Irfan Dotani Synonyms and Keywords: Hematothorax; haemothorax Overview Historical Perspective Classification Pathophysiology Causes Differentiating Hemothorax from other Diseases Epidemiology [wikidoc.org]
Three ways of entry of air into the pleural cavity are described within the pathophysiology of pneumothorax: (A) communication between the alveolar spaces and the pleura, (B) the presence of organisms that produce gas in the pleural space, and (C) the [hindawi.com]
Obtaining a chest x-ray will reveal lung pathophysiology, but it will not reveal information related to oxygenation levels. [quizlet.com]
Prevention
Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracostomy. Chest 1994;106:1493-1498. Fallon WF Jr, Wears RL. [east.org]
Anesthesia should be started rapidly, and all maneuvers should be employed to prevent aspiration. [emedicine.medscape.com]
Treatment for hemopneumothorax is aimed at draining the air and blood in the chest, returning the lung to normal function, preventing complications, and repairing any wounds. [healthline.com]
References
- 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.
- 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.
- 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.
- 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.
- 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.
- Chong K, Qureshi SA, Badea G, Lok S. Spontaneous haemopneumothorax. BMJ Case Rep. 2011;2011:bcr0420114065.
- 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.
- Hart SR, Willis C, Thorn A, et al. Spontaneous haemopneumothorax: are guidelines overdue? Emerg Med J 2002;19:273–274.
- 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.