Spontaneous haemopneumothorax: current management

Abstract

Spontaneous haemopneumothorax (SHP) can be life threatening and is an important cause for unexplained signs of significant hypovolaemia. There is still some debate relating to patient selection and timing of surgery, particularly in those who become stable following chest tube insertion without further blood loss. Review of the literature over the past decade in the management of SHP are presented and discussed. Surgery should be considered early in the management of SHP to reduce morbidity associated with continued haemorrhage and inadequate drainage. Lower postoperative complications and shorter hospital stay following video assisted thoracic surgery compared with thoracotomy have led to its increased acceptance as an alternative approach for SHP patients who are haemodynamically stable.

Spontaneous Hemopneumothorax: A Rare Cause of Unexplained Hemodynamic Instability in a Young Patient

“…Therefore, clinicians acting on emergency departments must be aware of SHT as a diagnostic possibility in young male patients presenting with abrupt onset of hypovolemia signs with no apparent cause, despite being an unusual condition [1].…”

“…The definition of SHT is not yet unanimous in the literature. Some authors adopt the concept proposed by Ohmori in 1988 as the accumulation of more than 400 ml of blood in the pleural cavity associated with primary spontaneous pneumothorax (PSP) [1,4,6]. On the other hand, a recent meta-analysis proposed that any hemothorax accompanying spontaneous pneumothorax is a more reasonable definition for this condition once there are cases reported in the literature in which the initial drainage was less than 400 ml [2,7].…”

“…The incidence of SHT has been reported to be around 1-12% of all PSP. A notorious predisposition for male patients is well documented, as the male to female ratio range is approximately 15 : 1, difference significantly higher compared to PSP [1,7,8].…”

“…Upright CXR is a routinely diagnostic tool by demonstrating typical radiological evidence of pneumothorax associated with an air-fluid level, even though up to 10% of cases may present only with pneumothorax on a first moment due to the early execution of this diagnostic testing or to the contention of the bleeding by a pleural adhesion. CT is normally not necessary, but it may be helpful if the diagnosis remains uncertain or to exclude secondary causes of hemothorax [1,7].…”

“…Over the past one and a half century, spontaneous hemopneumothorax (SHP) has emerged as a rare well-documented entity in the literature, being first described by Laënnec in 1828, and it complicates about 1-12% of all spontaneous pneumothoraces. Although uncommon, SHP is a potentially life-threatening condition and, therefore, must be remembered in the context of sudden onset of unexplained hemodynamic instability, especially in young males, since proper and immediate management in these cases is a determining factor for both treatment success and to improve prognosis [1].…”