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

Abstract

Spontaneous hemopneumothorax is a rare and potentially life-threatening disorder which complicates about 1-12% of patients presenting with spontaneous pneumothorax and has a remarkable predilection for male patients. It may present with signs of hypovolemic shock without apparent cause. While there are no specific guidelines for the management of patients diagnosed with such condition, wide debate in the literature relating to patient selection for surgery remains unresolved, and recently there seems to be a trend increasingly favorable towards early surgical intervention. Video-assisted thoracic surgery emerges as an excellent option for stable patients and has now been considered the gold standard treatment for spontaneous hemopneumothorax. We report the case of a 17-year-old male patient who presented to the emergency department with a history of sudden chest pain and dyspnea, with no previous evidence of trauma. 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.

Curative Effect Observation and Prognosis Analysis of Video-Assisted Thoracic Surgery and Thoracotomy in Patients with Hemopneumothorax

“…Hemopneumothorax is one of the common complications of chest trauma, and some studies have reported that more than 60% of chest trauma patients have different degrees of hemopneumothorax, resulting in hypotension, pallor, shortness of breath, chest tightness, and other symptoms, which can cause aggravation such as hemorrhage in the chest cavity if not treated in time and may even cause death of patients in serious cases [14,15]. In the past, the treatment of traumatic hemopneumothorax was usually carried out by means of debridement sutures and closedchest drainage, and the decision of whether to open the chest for exploration was made according to the size of chest drainage, which was not conducive to the judgment of the patient's condition at an early stage and delayed the timing of treatment [16]. oracotomy allows exploration of the patient's chest cavity and timely and effective treatment, which has been a better tool for hemopneumothorax management in the past [17].…”

Spontaneous hemopneumothorax in a 16-year-old-boy: a case report

“…O diagnóstico do hemopneumotórax deve incluir uma anamnese detalhada, exame físico, exames laboratoriais e exames de imagem como radiografia simples ou TC. Com relação ao exame físico, o paciente pode apresentar-se hemodinamicamente estável na admissão, com boa saturação de oxigênio em ar ambiente, temperatura corporal adequada, frequência respiratória e pressão arterial dentro dos limites esperados 1,10,14,15 . No entanto, é importante lembrar que, conforme relatado anteriormente, alguns pacientes podem dar entrada no pronto-socorro já em estado de choque.…”

“…A ausculta cardíaca normalmente encontra-se sem alterações, porém, na presença de extenso hemopneumotórax, pode apresentarse alterada. Em um dos artigos analisados, por exemplo, foi auscultado abafamento das bulhas cardíacas em foco mitral de um paciente com volumoso HPTE 1 . Nos exames laboratoriais, o principal parâmetro analisado é o nível sérico de hemoglobina, que, em um paciente masculino saudável, varia, em geral, de 14 a 18 g/dL e, em nosso caso, assim como em relatos encontrados na literatura, os pacientes possuíam baixos níveis de Hb, refletindo a perda volêmica 1,14 .…”

“…O Hemopneumotórax espontâneo (HPTE), descrito pela primeira vez por Laënnec durante uma autópsia em 1828, é uma condição rara e potencialmente fatal 1 . O HPTE é caracterizado pelo acúmulo de sangue na cavidade pleural em associação com um pneumotórax espontâneo (PE), ou seja, não está relacionado com eventos traumáticos 2 .…”

Primary Spotan Hemopneumothorax: A Case Report

“…Initial treatment after prompt diagnosis of patients is adequate fluid replacement and drainage of the pleural space. Therefore, early diagnosis and treatment are important (5).…”