대한흉부영상의학회 Weekly Chest Cases

Case No : 821 Date 2013-07-22

Courtesy of Jeong Min Ko, Hyun Jin Park / St. Vincent
Age/Sex 23 / M
Chief ComplaintAcute-onset chest pain and dyspnea. No trauma history

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Diagnosis With Brief Discussion

Diagnosis: Spontaneous hemopneumothorax
Radiologic Findings: Supine chest radiograph shows findings of consistent with tension hydropneumothorax of right pleural cavity.
Image from contrast enhanced CT scan after chest tube insertion demonstrates a right-sided hemothorax. A focus of active extravasation of contrast material into right upper pleural cavity is also noted.
Brief Review: Spontaneous hemopneumothorax (SHP) is defined as the accumulation of > 400 ml of blood in the pleural cavity in association with spontaneous pneumothorax, is a rare entity occurring in young patients (mean age, 22.1 to 34.0 years) and may be life threatening. There are said to be three mechanisms of bleeding in hemopneumothorax. First, bleeding can results from a torn adhesion between the parietal and visceral pleura. The site of bleeding is usually a small noncontractile vessel on the parietal pleura, where vascular adhesions exist. Second, bleeding may result from the rupture of vascularized bullae and underlying lung parenchyma. Third, it may result from torn congenitally aberrant vessels between the parietal pleura and bullae.
Although, there is still some debate about the management of the patient who stabilizes after a chest tube insertion without further blood loss, the predominant opinion favors prompt surgical management for most of the patients with SHP, particularly in a patient who is in shock, has rebleeding after lung expansion, or fails conservative management after 24 hours. This is widely considered to be a surgical emergency because of the capability of the vessels to bleed freely.
References: 1. Ali HA, Lippmann M, Mundathaje U, Khaleeq G. Spontaneous hemothorax: a comprehensive review. Chest. 2008 Nov;134(5):1056-65.
2. Hsu NY, Shih CS, Hsu CP, Chen PR. Spontaneous hemopneumothorax revisited: clinical approach and systemic review of the literature. Ann Thorac Surg. 2005 Nov;80(5):1859-63.
Please refer to: Case 437
Keywords: Pleura,

No. of Applicants : 60

▶ Correct Answer : 6/60, 10.0%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- radiologist, aditya imaging centre , India vivek patel
- GHOL, Hopital de Nyon , Switzerland Benoit Rizk
- IRSA La Rochelle , France Denis Chabassiere
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN

▶ Correct Answer as Differential Diagnosis : 3/60, 5.0%

- Kyoto University , Japan Akihiko Sakata
- Seoul National University Hospital , Korea (South) YongSub Song
- Shiga University of Medical Science , Japan Akitoshi Inoue

▶ Semi-Correct Answer : 4/60, 6.7%

- MBAL Chernomorska , Bulgaria VLADISLAV RUSINOV
- Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
- TCM HOSPITAL OF ZIGONG , China Cao Cunyou
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 821 Date 2013-07-22

Discussion

No. of Applicants : 60