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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].

Right Upper Quadrant Pain
  • KEYWORDS: acute abdomen; right upper quadrant pain; spontaneous hemopneumothorax[ncbi.nlm.nih.gov]
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]
  • 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]
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]
Tingling
  • 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].

Pleural Adhesions
  • Bridging veins and torn pleural adhesion between parietal and visceral pleura were the source of bleeding determined at thoracotomy. Hematoma evacuation, resection of bullae, ligation of pleural adhesions and apical pleurectomy were performed.[ncbi.nlm.nih.gov]
  • In all patients, the cause of hemopneumothorax was a torn pleural adhesion band.[ncbi.nlm.nih.gov]
  • Both patients were treated with chest tube suction, but 1 required surgical decortication of fibrinous pleural adhesions.[ncbi.nlm.nih.gov]
  • […] hydrothorax induced pneumothorax interstitial emphysema interstitial spaces lesser circulation lung re-expands Mediastinal mediastinum mixed infection onset oxygen parietal pleura parietal wall patient perforation persistent pneumothorax Physical signs pleural[books.google.com]
  • For patients with pleural adhesions or loculations (i.e., a patient in the ICU who has had multiple chest tubes), this may not apply. 0 0 Take-home points Hydro-point is the ultrasonographic representation of an air-fluid level in the pleural space.[emcrit.org]

Treatment

  • The long-term outcome of our patients with early surgical indication was excellent and we recommend early surgical treatment for SHP.[ncbi.nlm.nih.gov]
  • 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]
  • Video-assisted thoracoscopic surgery may be considered as an initial treatment procedure for patients with spontaneous hemopneumothorax, whereas conservative treatment is effective and may be performed in selected patients.[ncbi.nlm.nih.gov]
  • In conclusion, conservative treatment is efficient and should be performed if bleeding persists for less than 24 hours after chest tube placement.[ncbi.nlm.nih.gov]
  • Conservative treatment is adequate in most cases and should be performed if bleeding persists for less than 24 hours after chest tube placement.[ncbi.nlm.nih.gov]

Prognosis

  • Hemopneumothorax developing soon after metastasis to the lung indicates on unfavorable prognosis.[ncbi.nlm.nih.gov]
  • The symptoms, clinical forms, differential diagnosis, course, prognosis and therapy of spontaneous hemopneumothorax are discussed in chapters 4, 5, 7 and 8.[jamanetwork.com]
  • View Article PubMed Google Scholar Chon SH, Lee CB, Kim H, Chung WS, Kim YH: Diagnosis and prognosis of traumatic pulmonary psuedocysts: a review of 12 cases. Eur J Cardiothorac Surg. 2006, 29: 819-823. 10.1016/j.ejcts.2006.01.054.[jmedicalcasereports.biomedcentral.com]
  • Prognosis Up to 50% of patients who suffer from a pneumothorax will have another or a recurring pneumothorax. However, there are no long-term complications after successful treatment.[physio-pedia.com]

Etiology

  • Although many theories about the pathogenesis were suggested, the etiology of this syndrome remains obscure.[minervamedica.it]
  • The history of trauma usually delineates any contusion, but if the cavitary lesion in question does not decrease with time, other etiologies must be considered[ 10 , 11 ]. Conclusions TPP is a rare complication of blunt chest trauma.[jmedicalcasereports.biomedcentral.com]
  • Determine etiology and precipitating factors (spontaneous collapse, trauma, malignancy, infection , complication of mechanical ventilation ).Understanding the cause of lung collapse is necessary for proper chest tube placement and choice of other therapeutic[nurseslabs.com]
  • Attention to the fluid characteristics may provide some clues regarding underlying etiology.[emcrit.org]
  • “Prehospital Pathophysiology” provides an opportunity for EMS providers to either refresh their knowledge related to the etiology of a certain disease or expand their knowledge base regarding common and not-so-common disease processes.[emsworld.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]
  • […] hemopneumothorax simulating acute abdominal affections. ( 23169600 ) Chen T.H....Lin T.J. 2014 15 Recurrent catamenial hemopneumothorax treated by coverage with polyglycolic acid sheets. ( 22982032 ) Takahashi M....Mino N. 2013 16 Spontaneous hemopneumothorax: epidemiological[malacards.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]
  • Obtaining a chest x-ray will reveal lung pathophysiology, but it will not reveal information related to oxygenation levels.[quizlet.com]
  • 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]
  • 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]
  • 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]
  • ) Kakaris S....Skottis I. 2004 43 Autologous salvaged blood transfusion in spontaneous hemopneumothorax. ( 15276557 ) Sakamoto K....Takanashi Y. 2004 44 Use of presumptive antibiotics following tube thoracostomy for traumatic hemopneumothorax in the prevention[malacards.org]
  • Anesthesia should be started rapidly, and all maneuvers should be employed to prevent aspiration.[emedicine.medscape.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: 2018-06-22 08:01