Treatment of spontaneous hemopneumothorax in a 16-year-old child

Abstract

Introduction. Spontaneous hemopneumothorax is a life-threatening rare disease that requires emergency measures aimed at eliminating pneumothorax, stopping bleeding, as well as controlling vital functions of the body.
 Purpose. To describe a rare clinical case with successful application of minimally invasive technologies.
 Description of the clinical case. A case of successful treatment of spontaneous hemopneumothorax in a 16-year-old child is presented. The patient was admitted to the hospital with complaints of fainting, lethargy, weakness, chest pain. Multispiral computed tomography (MSCT) of the chest was immediately performed and revealed a total right-sided strained hydropneumothorax. The pleural cavity was drained; up to 2000 ml of blood was obtained. After that procedure, the child’s blood pressure dropped and was restored with the infusion of crystalloid solutions. Over the next 2 hours, another 200 ml of blood were discharged. Hemotransfusion of freshly frozen plasma and erythrocyte mass was performed. Upon further observation, the discharge stopped, there was no air flow. After patient’s condition was stabilized, thoracoscopy was made next day. In the pleural cavity , a large number of blood clots was revealed; the cavity was sanitized. Blebs up to 0.5 cm in diameter were found on the top of the right lung; no other organic pathology and any sources of ongoing bleeding were detected. A typical resection of the apical segments of the lung was made. The patient was discharged on day 7.
 Conclusion. Successful treatment of a patient with spontaneous hemopneumothorax has been demonstrated. With this complication of spontaneous pneumothorax, early surgical treatment is indicated, with a stable condition, thoracoscopy is performed. The resulting recurrence of pneumothorax raises the question of performing a pleurectomy first.