Unusual case of primary spontaneous hemopneumothorax in a young man with atypical tension pneumothorax: a case report

Abstract

BackgroundSpontaneous life-threatening hemopneumothorax is an atypical but treatable entity of unexpected circulatory collapse in young patients, affecting 0.5–11.6% of patients with primary spontaneous pneumothorax. Spontaneous pneumothorax is a well-documented disorder with a classic clinical presentation of acute onset chest pain and shortness of breath. This disorder might be complicated by the development of hemopneumothorax or tension pneumothorax.Case presentationA 23-year-old Asian man was referred to the emergency room of Xiamen Chang Gung Memorial Hospital with a 1-day history of right-sided chest pain that had been aggravated for 1 hour. A physical examination revealed a young man who was awake and alert but in mild to moderate painful distress. His vital parameters were relatively stable at first. The examining physician noted slight tenderness along the right posterolateral chest wall along the eighth and tenth ribs. Primary spontaneous pneumothorax was considered, and a standing chest X-ray confirmed the diagnosis. A right thoracostomy tube was immediately placed under sterile conditions, and he was referred to the respiratory service. While in the respiratory department, approximately 420 mL of blood was drained from the thoracostomy tube over 15 minutes. Our patient developed obvious hemodynamic instability with hypovolemic shock and was subsequently admitted to the cardiothoracic surgical ward after fluid resuscitation. During the ensuing 4 hours after admission, 750 mL of blood was drained through the thoracostomy tube. A bedside chest X-ray was requested after he was temporarily hemodynamically stabilized. Primary spontaneous hemopneumothorax associated with right tension pneumothorax was considered based on the radiological impression and clinical signs. An emergency limited posterolateral thoracotomy was performed. A standing chest X-ray performed on day 6 of admission after the removal of the thoracostomy tube showed a complete re-expansion of his right lung. He remained stable and was discharged within 1 week.ConclusionsThe successful treatment of a large spontaneous hemopneumothorax depends on early recognition, proactive intervention, and early consideration by a cardiothoracic surgeon. Once the diagnosis is confirmed, early thoracotomy should be considered. Such an aggressive surgery not only leads to shorter hospitalization but also confers better long-term outcomes.

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

“…The most frequent presenting symptoms are chest pain and sudden dyspnea. Although their initial clinical manifestations may be very similar, the potential development of hypovolemic shock leading to rapid clinical deterioration distinguishes SHT from PSP, as can be observed in our case as well as in many other case reports [6,[9][10][11][12]. A study by Kakaris et al pointed out that, among 71 patients diagnosed with SHT, 29.5% presented hemodynamic instability upon admission [3].…”

“…The definition of SHT is not yet unanimous in the literature. Some authors adopt the concept proposed by Ohmori in 1988 as the accumulation of more than 400 ml of blood in the pleural cavity associated with primary spontaneous pneumothorax (PSP) [1,4,6]. On the other hand, a recent meta-analysis proposed that any hemothorax accompanying spontaneous pneumothorax is a more reasonable definition for this condition once there are cases reported in the literature in which the initial drainage was less than 400 ml [2,7].…”

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

“…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]. At this stage, however, the trauma caused by thoracotomy and the occurrence of postoperative complications make it difficult for the physician to decide whether to perform thoracotomy to staunch bleeding [18].…”

Polytrauma with Grade-IV Liver Laceration and Grade-II Renal Laceration: A Case Report

“…Spontaneous pneumothorax is a welldocumented condition characterized by shortness of breath and abrupt chest pain, this condition may lead to hemopneumothorax or tension pneumothorax. (3) The liver is the most common organ which is injured during any blunt abdominal traumas(4). Usually, liver injuries are not considered major and classified or graded.…”