PubMed · 14844084
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M JOSELEVICH, H M CASSANO, L SUCARI. 1951-05-11. [Spontaneous hemopneumothorax; comments on a case].. https://pubmed.ncbi.nlm.nih.gov/14844084/
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PURPOSE OF REVIEW: Spontaneous hemopneumothorax can be life threatening, and is a cause of patients presenting with unexplained signs of significant hypovolemia. The debate relating to patient selection and timing of surgery in patients with spontaneous hemopneumothorax remains unresolved. RECENT FINDINGS: Our experience together with the latest series published over the last decade on the conservative and surgical management of spontaneous hemopneumothorax are presented and discussed. SUMMARY: Surgery should be performed early in the management of spontaneous hemopneumothorax to reduce morbidity. In particular, video-assisted thoracic surgery, which is associated with potentially fewer post-operative complications and shorter hospital stays compared with thoracotomy, should be considered in patients with spontaneous hemopneumothorax who are hemodynamically stable.
A 57-year-old man came to our hospital by ambulance for a chest injury by a rifle gunshot. He had a penetrating injury of the chest wall, hemopneumothorax and pulmonary laceration. He was managed with chest drainage, oxygen inhalation. His respiratory and cardiac status was stable. However, for the purpose to prevent the development of empyema or pneumonia, and to check the existence of damage of intrathoracic structures by the gunshot injury, thoracoscopy was performed next day. He discharged without postoperative complications 17 days after the injury. Open thoracotomy is reported to be required in only about 10-15% of patients with chest injuries. However, operative indication of the chest injuries may spread in the future with the spread of thoracoscopy and its low invasiveness.
A 55-year-old man was admitted to the private hospital with chief complaints of left chest pain and increasing dyspnea. Chest X ray on admission revealed a collapsed lung and an air fluid line in the left hemothorax. A chest tube drainage was carried out, but hemorrhagic pleural fluid of 1,000 ml was drainaged. So was the patient transferred to our hospital for surgical treatment. Following blood transfusion because of hemorrhagic pleural fluid of 1,500 ml, urgent surgery was carried out. At the operation under thoracoscope, the bleeding from the apex of the thoracic cavity was noted. The bleeding was controlled with endoscopic surgical clip. As it was, however, very difficult to remove massive blood clots under endoscopic surgery, a small thoracotomy was carried out in addition to the thoracoscopic surgery, then the bulla in the apex of left lung was resected and also removed a large amount of blood clots.