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Hemopneumothorax

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].

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]
Anorexia
  • He had history of weight loss and anorexia for one month duration. The patient was tall, thin, looking ill and pale. He was dyspneic, but nearly absent air entry on the left side.[edoriumjournalofctvs.com]
Labored Breathing
  • Symptoms include: sudden chest pain that gets worse after coughing or taking a deep breath difficult or labored breathing (dyspnea) shortness of breath chest tightness tachycardia (rapid heart rate) pale or blue skin caused by lack of oxygen The pain[healthline.com]
Hypotension
  • 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]
  • 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]
  • 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]
Distended Neck Veins
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]
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]

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].

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.[ncbi.nlm.nih.gov]
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.[ncbi.nlm.nih.gov]

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 thorax[ncbi.nlm.nih.gov]

Prognosis

  • Hemopneumothorax developing soon after metastasis to the lung indicates on unfavorable prognosis.[ncbi.nlm.nih.gov]
  • 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]
  • Although many theories about the pathogenesis were suggested, the etiology of this syndrome remains obscure.[minervamedica.it]
  • 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]
  • 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]
  • In our patient, the etiology of hemothorax was probably similar to the first of the three mechanisms described above, that is, rupture of a vessel associated with a visceral-parietal adhesion.[journals.lww.com]

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]
  • […] 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]
  • ., 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 and Demographics[wikidoc.org]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology Endometriosis can attach to the lung, forming chocolate-like cysts.[answers.yahoo.com]
  • Also discussed will be assessment and treatment problems relating to the pathophysiology of these injuries.[emsworld.com]
  • 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]
  • ., 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 and Demographics[wikidoc.org]
  • View Article PubMed Google Scholar Moore FA, Moore EE, Haenel JB, Waring BJ, Parsons PE: Post-traumatic pulmonary pseudocyst in the adult: pathophysiology, recognition, and selective management.[jmedicalcasereports.biomedcentral.com]

Prevention

  • This fluid holds the two membranes together by surface tension, as much as a drop of water between two sheets of glass prevents them from separating.[en.wikipedia.org]
  • Preventive antibiotic usage in traumatic thoracic injuries requiring closed tube thoracostomy. Chest 1994;106:1493-1498. Fallon WF Jr, Wears RL.[east.org]
  • Prevention of recurrence is difficult, as the recurrence rate is high, treatment duration is potentially long, and residual thoracic pain during menstruation is sometimes seen.[minervamedica.it]
  • Heparin If a thrombolytic agent is not used, treatment is aimed at preventing extension of the clot and the formation of additional clots. Heparin will prevent clot extension.[quizlet.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

Article

  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.

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Last updated: 2019-07-11 21:45