Discussion
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
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- Keywords
- Pleura,