Spontaneous Hemopneumothorax in Children: Case Report and Review of Literature

Abstract

Spontaneous hemopneumothorax is rare, occurs in young adolescents, and can be life threatening secondary to massive bleeding. An adolescent with spontaneous hemopneumothorax and shock managed by tube thorascostomy is described here. We compared our case with published data of spontaneous hemopneumothorax in the pediatric age group. Spontaneous hemopneumothorax involves the accumulation of air and blood in the pleural space in the absence of trauma or other obvious causes. Spontaneous hemopneumothorax is usually seen in adolescents, more common in males than females. The common clinical features of spontaneous hemopneumothorax include dyspnoea and chest pain, and 30% present with hypovolemic shock. The bleeding can result from a torn adhesion between the parietal and visceral pleurae, from a rupture of vascularized bullae, or from torn congenital aberrant vessels. Over the last 6 decades, the treatment has progressed from the thoracotomy to minimally invasive techniques such as video assisted thoracoscopic surgery, with great reduction in mortality and recurrence rates. Although a rare entity, diagnosis of spontaneous hemopneumothorax must be considered in young adolescents presenting with spontaneous onset of chest pain and dyspnoea with radiograph findings of hydropneumothorax and/or signs of shock.

Hemopneumothorax caused by vascularized bullae and a pulmonary hemangioma in an adolescent boy

“…In the review of pediatric cases of Issaivanan et al [3], 3 had aberrant vessels, 3 had vascularized blebs, 1 had a parietal pleural vessel, and 1 had a congenital cystic adenomatoid malformation. A similar review of 24 patients with SPH [6] showed a similar distribution but had 6 patients without an obvious source of bleeding.…”

“…In cases with excessive bleeding of greater than 100 mL/h or hemodynamic instability, surgery by either video-assisted thoracic surgery (VATS) or thoracotomy is recommended [7]. There have not been any case reports of patients treated with VATS or thoracotomy who recur [3].…”

“…Most studies report that hemopneumothorax occurs in 1% to 2% of all pneumothoraxes [2]. A review by Issaivanan et al [3] of 10 cases confirmed these findings in the adolescent population, with a 4:1 male-to-female predominance. Approximately 30% of the patients in their review developed hypovolemia, and the authors identify those patients as losing more than 1200 mL of blood.…”

Spontaneous hemopneumothorax simulating acute abdominal affections

“…The pathophysiology of SHP involves the accumulation of air and blood in the pleural cavity with no trauma or other obvious causes. Three mechanisms of hemorrhage in SHP are: from torn adhesions of pleura, from a rupture of vascularized bullae, or from torn congenital aberrant vessels . SHP is usually seen in adolescents older than 15 years of age.…”

Spontaneous hemothorax during general anesthesia

“…Rupture of these vascularized bullae can cause a spontaneous hemopneumothorax (SHP) [7]. SHP is a rare event occurring in young patients with a male predominance [8]. Bullae can rupture during positive-pressure ventilation secondary to barotraumas [9].…”