Two Cases of Shocked Spontaneous Hemopneumothorax After Chest Tube Drainage

Shinohara, Toshihiko; Mitumori, Norio; Nojiri, Takuya; Asakura, Jun; Doi, Naoki; Miyoshi, Isao; Yamazaki, Yoji

doi:10.3919/jjsa.60.2086

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…Of further note, the drain may make actually worsen bleeding, as in our cases. At least 16 cases of hemorrhagic shock developing after the chest drain was inserted have been reported in Japan [ 6 ]. Shinohara et al [ 6 ] hypothesized a mechanism in which the relief of the pneumothorax by drain insertion re-encouraged the bleeding that had been weakened by the tension induced by pneumothorax.…”

Section: Discussionmentioning

confidence: 99%

“…At least 16 cases of hemorrhagic shock developing after the chest drain was inserted have been reported in Japan [ 6 ]. Shinohara et al [ 6 ] hypothesized a mechanism in which the relief of the pneumothorax by drain insertion re-encouraged the bleeding that had been weakened by the tension induced by pneumothorax. Furthermore, 20–30% of patients that achieved hemostasis with conservative therapy ultimately required surgical intervention or showed a prolonged hospital stay due to reactive fluid collection, clot empyema or persistent air leak [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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A case of spontaneous hemopneumothorax in which the condition worsened after chest drainage

Nose

Mori

Yonei

et al. 2018

Journal of Surgical Case Reports

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A 45-year-old woman was referred to our hospital with sudden chest pain. She came on foot with normal vital signs. Computed tomography (CT) revealed right mild pneumothorax with niveau level. We suspected spontaneous hemopneumothorax (SHP) and inserted a thoracic drain. After 800 ml of blood and air was evacuated immediately, the outflow from the drain stopped. However, despite the outflow of blood from the drainage tube having stopped, she developed hemorrhage shock 2 h after drainage. Contrast-enhanced CT revealed extra-vascular signs at the top of the right pleural cavity. Emergency video-assisted thoracic surgery (VATS) was performed. We identified the chest drain as being obstructed by blood clot. Continuous bleeding from a small aberrant vessel at the top of the thoracic cavity was identified, and we stanched it easily by clipping. The present experience suggests that routine enhanced CT and aggressive emergent VATS should be performed in cases of SHP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A case of spontaneous hemopneumothorax in which the condition worsened after chest drainage

Nose

Mori

Yonei

et al. 2018

Journal of Surgical Case Reports

View full text Add to dashboard Cite

show abstract

Spontaneous hemopneumothorax causing life-threatening hemorrhage: a case report

Nishikawa,

Shimizu,

Banno

et al. 2024

J Med Case Reports

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Background Spontaneous hemopneumothorax is a rare condition that can be life-threatening if not promptly diagnosed and treated. We report a case of early treatment with transcatheter arterial embolization and video-assisted thoracoscopic surgery. Case presentation A 19-year-old Japanese male was diagnosed with left pneumothorax and underwent chest tube drainage. A total of 10 hours after admission, the patient developed dyspnea, chest pain, and sudden massive bloody effusion. Contrast-enhanced computed tomography revealed contrast extravasation near the left lung apex, and spontaneous hemopneumothorax was diagnosed. Angiography revealed bleeding from a branch of the subscapular artery and transcatheter arterial embolization was performed. The patient underwent video-assisted thoracoscopic surgery and recovered uneventfully. Conclusions Anesthesiologists involved in urgent surgeries must be aware that a patient with spontaneous pneumothorax can develop a hemopneumothorax, even when full lung expansion has been obtained following chest tube drainage, owing to latent aberrant artery disruption. Interprofessional team engagement is essential for spontaneous hemopneumothorax management.

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Two Cases of Shocked Spontaneous Hemopneumothorax After Chest Tube Drainage

Cited by 2 publications

References 2 publications

A case of spontaneous hemopneumothorax in which the condition worsened after chest drainage

A case of spontaneous hemopneumothorax in which the condition worsened after chest drainage

Spontaneous hemopneumothorax causing life-threatening hemorrhage: a case report

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