Spontaneous pulmonary hematoma with diffuse pulmonary ossification requiring emergency treatment: a case report

Abstract

Background Pulmonary hematoma is most often caused by thoracic trauma. However, rare cases of pulmonary hematoma without any obvious cause are sometimes reported, when the condition is referred to as spontaneous or idiopathic pulmonary hematoma. Herein, we report a very rare case—to the best of our knowledge, this is the first case of pulmonary hematoma associated with diffuse pulmonary ossification requiring emergency treatment reported in the English literature. Case presentation Our patient was a 44-year-old man with a history of IgA nephropathy and had no history of trauma or anticoagulant use. He presented with the chief complaint of bloody sputum and was referred to our hospital for detailed examination. Chest computed tomography showed a right pleural effusion and a large round mass in the right lower lobe. We performed chest tube drainage of the right thorax and confirmed bloody pleural effusion. Although bronchial artery embolization was performed, the patient’s anemia worsened, and we performed right lower lobectomy. Histopathological examination of the resected specimen showed a hematoma with diffuse pulmonary ossification, although the relationship between the two was unclear. There was no evidence of malignancy or angiitis. Therefore, we made the diagnosis of spontaneous pulmonary hematoma in this case. The postoperative course was uneventful. The patient is currently under observation as an outpatient, and a recent chest X-ray showed no evidence of recurrence. Conclusion We report a case of spontaneous pulmonary hematoma with diffuse pulmonary ossification. Although the relationship between the two remains unclear, considering the possibility of appearance of new lesions/recurrence, we believe that careful follow-up is necessary for this patient.

Rare findings of spontaneous hemothorax and small subpleural lung hematoma in a COVID-19 patient: A case report

“…22,23 Spontaneous PH appears on CT as a round hyperdense shape and can be caused by vessel rupture and subsequent hemorrhage, or it can occur in a preexisting cyst via angionecrosis and the erosion of the cystic wall. 7,10,24,25 The treatment of PH is usually conservative, 7 while the treatment of HT consists of chest tube drainage.…”

“…Hemothorax (HT) and pulmonary hematoma (PH) are usually secondary to chest trauma. 6 , 7 Spontaneous HT is a rare and life-threatening condition that can be caused by tumors, arteriovenous malformations, pulmonary emboli, endometriosis, and neurofibromatosis. 6 , 8 Spontaneous HT due to anticoagulant therapy such as that with warfarin, apixaban, and low-molecular-weight heparin (LMWH) has only emerged in case reports.…”