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PubMed1977

Massive hemothorax complicating heparin anticoagulation for pulmonary embolus.

A case of massive hemothorax complicating heparin anticoagulation for pulmonary thromboembolism is presented. Hemothorax complicating anticoagulant therapy for PTE usually occurs within the first week of treatment and is invariably on the side of the initial clinical symptoms, suggesting intrapleural rupture of a hemorrhagic pulmonary infarct. Late hemothorax is unusual and may not be on the side of the initial symptoms, suggesting a different pathogenesis. Hemothorax may occur as the only bleeding complication of anticoagulation and when coagulation studies are within an acceptable therapeutic range. Cessation of anticoagulation therapy and prompt evacuation of the pleural space are recommended.

Hemothorax↗
PubMed1997

Hemothorax and chylothorax.

Hemothorax and chylothorax remain perplexing medical problems. The primary cause of hemothorax is trauma, whereas the primary cause of chylothorax is cancer. Most patients with hemothorax can be treated with chest tube drainage only. Early thoracotomy with thoracic duct ligation is recommended for patients with chylothorax when conservative treatment with chest tube drainage and hyperalimentation fails. Radiation therapy is the mainstay of treatment for chylothorax related to cancer. Video-assisted thoracoscopy may play an increasing role in the surgical treatment of both hemothorax and chylothorax.

Chest Tubes↗
PubMed2007

Isolated costal hyperostosis: a rare cause of severe hemothorax.

Chest pain due to hemothorax is rare. However, the possibility of traumatic hemothorax must always be suspected. We report a case of a 15-year-old girl with hemothorax after erosion of the intercostal artery of the left seventh rib by a histological proved solitary costal hyperostosis. She presented with a 2-month history of intermittent left-sided chest pain and 3 episodes of acute chest pain followed by dizziness and loss of consciousness. The chest radiograph revealed a large left pleural effusion and a thin-section chest computed tomography scan that was performed after drainage of the hemothorax indicated a spicule projecting inward into the chest from the left seventh rib. After thoracotomy, a solitary costal hyperostosis causing a traumatic pseudoaneurysm of the intercostal artery was removed by partial resection of the left seventh rib, the intercostals vessels were ligated, and the pseudoaneurysm excised.

Adolescent↗
PubMedDate not supplied

Bilateral and unilateral spontaneous massive hemothorax as a presenting manifestation of rare tumors.

Spontaneous true hemothorax is quite a rare manifestation of a presenting disease. This is a report of two patients, one with bilateral spontaneous massive hemothorax as a presenting manifestation of angiosarcoma involving the lungs and pleura, and the other with unilateral spontaneous hemothorax and hemorrhagic shock as a presenting manifestation of 'cystic' chondroblastoma. Differential diagnosis of spontaneous true hemothorax and its evaluation and management are discussed.

Adult↗
PubMed1998

Intrapleural fibrinolytic treatment of traumatic clotted hemothorax.

STUDY OBJECTIVE: To evaluate the role of intrapleural fibrinolytic treatment (IPFT) in traumatic clotted hemothorax. DESIGN AND PATIENTS: Between August 1995 and February 1997, 24 patients with traumatic clotted hemothorax were included. Streptokinase (SK), 250,000 IU, or urokinase (UK), 100,000 IU, diluted in 100 mL of saline solution was given daily. We administered 5.0+/-1.8 (range, 2 to 9) doses of SK or 6.25+/-5.97 (range, 2 to 15) doses of UK. SETTING: Dicle University School of Medicine, Thoracic and Cardiovascular Surgery Department. RESULTS: Complete response, which was defined as resolution of symptoms with complete drainage of fluid and no residual space radiographically, occurred in 15 (62.5%) patients. Partial response, which was defined as resolution of symptoms with a small pleural cavity, occurred in seven (29.2%) patients. Two patients (8.3%) required decortication; they were defined as nonresponders. The mean period of time between the diagnosis and fibrinolytic treatment (FT) was 11.65+/-6.38 (range, 4 to 25) days. There were no complications related to IPFT. There was no mortality during the course of IPFT. CONCLUSION: The use of intrapleural fibrinolytic agents has resulted in resolution of clotted hemothorax with an overall success rate of 91.7%. We recommend that IPFT should be added to the algorithm for management of clotted hemothorax before proceeding with minithoracotomy or pleural decortication.

Adolescent↗
PubMed2002

Videothoracoscopy for evaluation and treatment of hemothorax.

BACKGROUND: Hemothorax may be immediately life-threatening or lead to complications like empyema and fibrothorax. The first step of management is the placement of a tube thoracostomy which is efficacious in more than 80% of cases. Continuous bleeding and retained blood, instead, require surgical treatment. METHODS: From 1993 to 2000, 33 patients underwent videothoracoscopic treatment of hemothorax. It was post-surgical in 19 cases, spontaneous in 8 and post-traumatic in 6. Fifteen patients had a continuous bleeding (>1500 mL/24 hrs) and 18 patients a retained hemothorax (= or >500 mL). To better assess smaller retained collection 11 patients underwent both CT scans and trans-thoracic ultrasonography. Twenty-six patients (group 1) were operated within 7 days of the diagnosis and 7 after 10 days (group 2). Standard videothoracoscopic equipment was utilised with the patient under general anaesthesia and double lumen selective intubation. Two or three incisions were performed in axillary triangle (in the postsurgical ones we always utilised the existing incisions). Hemostasis was always achieved by clip ligation and electrocautery. Clotted blood underwent fragmentation and suction with a complete evacuation followed by pleural washing with antibiotics solution. RESULTS: Videothoracoscopy was effective in 32 cases. One patient of group 2 required conversion to open thoracotomy due to the presence of sticky pleural adhesions. Operating time, mean drainage period and mean hospital stay were sensitively shorter in patients of group 1 with respect to patients of group 2. At a mean follow-up of 39 months no relapses or complications were observed. CONCLUSIONS: Videothoracoscopy seems to be safe and effective in the treatment of hemothorax. To avoid prolonged operations, conversions to thoracotomy and complications, it should be performed as soon as possible. Actually only massive hemorrhages justify the thoracotomic approach.

Adolescent↗
PubMed2003

Delayed hemothorax after blunt trauma without rib fractures.

Delayed hemothorax after blunt trauma is a rare, significantly morbid entity described in the current literature associated with displaced rib fractures. This report describes a case of delayed hemothorax after blunt trauma without rib fracture. The patient presented to a routine clinic appointment 72 hours after injuring himself while snowboarding. Chest radiographs at initial visit were negative for significant pathology. Eight hours later, the patient presented again with worsening chest pain and dyspnea. Repeat radiographs revealed a large right-sided hemothorax. The patient was treated with tube thoracostomy and remained an inpatient for 6 days. This case is unique because, unlike previously reported delayed hemothorax after blunt trauma, this patient had no evidence of rib fractures.

Adult↗
PubMed1992

[Diagnosis and treatment of hemothorax in malignant trophoblastic tumors].

From 1949 to 1988, 32 cases of hemothorax were seen in our hospital. The incidence rate of hemothorax among the cases of choriocarcinoma and invasive mole in the whole series were 2.6% and 1.4% respectively. The most frequent symptoms were chest pain, cough, dyspnea, and hemoptysis. Before 1965, when 6-MP was the only agent used, 7 of the 16 patients with hemothorax died directly due to severe intrathoracic hemorrhage, from 1966 to 1988, when intravenous infusion of 5-FU and intrathoracic injection of 5-FU were used, only 4 of the 16 cases died, there was no death directly related to hemothorax. About 75% were followed up for more than 10 years, the longest duration of follow up being more than 28 years in 6 cases. Repeated examinations with serum hCG determination and chest film revealed no evidence of recurrence, nor pleural adhesion and thickening or pulmonocardiac diseases.

Female↗
PubMed1992

Spontaneous hemothorax. Report of 6 cases and review of the literature.

We present 6 cases of spontaneous hemothorax and comprehensively review the medical literature on this subject. We categorize the reported causes and offer a rational diagnostic approach to patients with nontraumatic hemothorax. We recommend specific treatments for specific etiologies, and emphasize the importance of well-established surgical principles for the treatment of hemothorax. Our suggestions should enable physicians to accurately diagnose and expeditiously treat patients with spontaneous hemothorax.

Adult↗
PubMed1992

[Autotransfusion in hemothorax patients].

From Nov. 1978 to Dec. 1988, autotransfusion was done in 25 patients, of which 23 suffered from traumatic hemothorax and 2 from spontaneous hemothorax. The amount of blood autotransfused was 500-2300ml (average 950ml). The time elapsed from accident was 5-44 hours (average 21 hours). Two patients had febrile reaction for a short period of time after operation. The rest recovered uneventfully. Hematological examination revealed that the quality of the blood collected from hemothorax was similar to that of the systemic blood of the patients and was superior to the stored blood. Free hemoglobin determination showed that 40% was in normal value (average 18.9%), and hemolysis was less serious than that of the blood after CPB. The results of aerobic and anaerobic cultures were negative. We believe that the quality of the blood collected from traumatic hemothorax was quite acceptable, and autotransfusion with such blood was adequate not only for war casualties but also for everyday emergency patients.

Adolescent↗
PubMed2004

Sonographic detection of pneumothorax and hemothorax in microgravity.

INTRODUCTION: An intrathoracic injury may be disastrous to a crew-member aboard the International Space Station (ISS) if the diagnosis is missed or delayed. Symptomatic or clinically suspicious thoracic trauma is treated as a surgical emergency on Earth, usually with immediate stabilization and rapid transport to a facility that is able to deliver the appropriate medical care. A similar approach is planned for the ISS; however, an unnecessary evacuation would cause a significant mission impact and an exorbitant expense. HYPOTHESIS: The use of ultrasound imaging for the detection of pneumothorax and hemothorax in microgravity is both possible and practical. METHODS: Sonography was performed on anesthetized pigs in a ground-based laboratory (n = 4) and microgravity conditions (0 G) during parabolic flight (n = 4). Aliquots of air (50-500 ml) or saline (10-200 ml) were introduced into the pleural space to simulate pneumothorax and hemothorax, respectively. RESULTS: The presence of "lung sliding" excluded pnemothorax. In microgravity, a loss of "lung sliding" was noted simultaneously in the anterior and posterior sonographic windows after 100 ml of air was introduced into the chest, indicating pneumothorax. The presence of the fluid layer in simulated hemothorax was noted in the anterior and posterior sonographic windows after 50 ml of fluid was injected into the pleural space. During the microgravity phase, the intrapleural fluid rapidly redistributed so that it could be detected using either anterior or posterior sonographic windows. CONCLUSION: Modest to severe pneumothorax and hemothorax can be diagnosed using ultrasound in microgravity.

Animals↗
PubMed1987

Autotransfusion from experimental hemothorax: levels of coagulation factors.

The coagulation system was investigated in five dogs undergoing autotransfusion from experimental hemothorax. One fourth of the blood volume was bled into the pleural space, drained, and autotransfused. The hemothorax blood showed: very prolonged PT and PTT; very low platelets and fibrinogen; midly elevated FDP; very low coagulation factors VIII, and V; reduced XII, prothrombin, X, XI, and VII. Partial clotting, mild fibrinolysis, and fibrin deposition over the pulmonary pleura seemed to cause incoagulability of hemothorax blood. Post autotransfusion arterial blood showed: normal PT and PTT; 25% decrease in platelets, and 31% decrease in fibrinogen from baseline values. There was also an overall 20% reduction of fibrinogen from baseline values. There was also an overall 20% reduction of all clotting factors, but their levels remained above 50% activity. It was concluded that autotransfusion from a hemothorax of 25% the blood volume in dogs causes a mild loss of hemostatic components, but does not significantly compromise the clotting mechanism.

Animals↗
PubMed1995

[A case of Von Recklinghausen's disease associated with a hemothorax due to a rapidly growing malignant schwannoma].

A 17-year-old man with Von Recklinghausen's disease was admitted to our hospital because of progressive dyspnea on exertion. A chest X-ray film showed a massive left pleural effusion. Thoracentesis revealed dark blood. Hemothorax was diagnosed, and digital subtraction angiography (DSA) was done. DSA revealed a large mass that was supplied with blood via the inferior phrenic artery, but revealed no active bleeding. An intercostal tube was inserted and 1700 ml of dark blood was drained. A chest X-ray film taken after drainage revealed a giant mass showing an extra-pleural sign in the left lung field. A thoracotomy was done to determine the source of bleeding. A giant tumor with hypervascular tissue was seen, and was diagnosed as a malignant schwannoma. No spontaneous hemorrhage from the artery was seen. The source of the hemothorax was believed to be hemorrhage from the tumor vessels. The tumor was treated conservatively, but it continued to grow rapidly and the patient died of respiratory failure. Five other patients have been reported to have hemothorax associated with Von Recklinghausen's disease. The sources of the hemothorax were reported to be hemorrhage from tumor vessels, or spontaneous rupture of the subclavian artery, an intercostal artery, or an intercostal vein.

Adolescent↗
PubMed2001

Hemothorax.

Hemothorax has been recognized as a clinical entity for centuries. However, the use of closed drainage has only recently been described in the last 50 years. Chest radiography remains the mainstay of diagnosis, however computed tomography and ultrasound are useful in some circumstances. The treatment of hemothorax is adequate drainage. Drainage allows for apposition of the visceral and parietal pleura, which aids hemostasis. Massive hemothorax and ongoing bleeding are indications for thoracotomy. Clotted hemothorax can be difficult to drain adequately with tube thoracostomy alone. Video assisted thoracic surgery (VATS) has proven most effective in obtaining adequate drainage if performed early in the patient's course.

Journal Article↗
PubMed2006

Spontaneous hemothorax caused by intrathoracic synovial sarcoma.

Synovial sarcoma, which is a soft tissue malignancy, primarily affects the extremities in the para-articular regions in adolescents and young adults. Synovial sarcoma of the pleural cavity is extremely uncommon, and there have been only a few reports in the literature. We report here an unusual case of left-sided spontaneous hemothorax as a presenting manifestation of intrathoracic synovial sarcoma in a 33-year-old pregnant woman. Spontaneous hemothorax, unrelated to trauma, is a very unusual clinical presentation, but we must consider entities with a physical risk assessment promptly because of the possible need for urgent management based on the hemodynamic condition of the patient. We should always be aware of possible causes of spontaneous hemothorax.

Adult↗
PubMedDate not supplied

Spontaneous hemothorax in neurofibromatosis treated with percutaneous embolization.

We evaluated the effectiveness of transcatheter arterial coil embolization therapy for the treatment of spontaneous hemothorax followed by aneurysm rupture in neurofibromatosis patients. Three patients were treated for massive hemothorax caused by arterial lesions associated with neurofibromatosis. Bleeding episodes were secondary to ascending cervical artery aneurysm and dissection of vertebral artery in 1 patient, and intercostal artery aneurysm with or without arteriovenous fistula in 2 patients. Patients were treated by transarterial coil embolization combined with chest drainage. In 1 patient, the ruptured ascending cervical artery aneurysm was well embolized but, shortly after the embolization, fatal hemorrhage induced by dissection of the vertebral artery occurred and the patient died. In the other 2 patients, the ruptured intercostal artery aneurysm was well embolized and they were successfully treated and discharged. Transcatheter arterial coil embolization therapy is an effective method for the treatment of spontaneous hemothorax followed by aneurysm rupture in neurofibromatosis patients.

Adult↗
PubMed1998

Spontaneous hemothorax in a hemodialysis patient.

An 8-year-old girl who had undergone chronic hemodialysis for 1 year presented with respiratory distress 24 h after a hemodialysis session. She had a massive pleural effusion of the left chest that was shown to be hemothorax by thoracentesis. After chest tube insertion, drainage was maintained for 2 days. Pleural effusion recurred after withdrawal of the chest tube. The antecubital arteriovenous fistula on the left arm was found to have an excessive flow with a thrill which was felt all over her left shoulder and left hemithorax. The pleural effusion resolved spontaneously a week after ligation of the fistula. Excessive flow in the arteriovenous fistula was thought to be the cause of the hemothorax and should be included in the differential diagnosis of hemothorax in hemodialysis patients.

Arteriovenous Fistula↗
PubMed2000

Hepatocellular carcinoma complicated by hemothorax.

Although hemoperitoneum is a well-known cause of death induced by rupture of hepatocellular carcinoma (HCC). hemothorax caused by rupture of HCC has not been adequately described. We report here a 64-year-old woman who died of bleeding from pleural wall metastasis of HCC. She presented with liver failure and sudden-onset hypotension, and on the same day, she died of hypovolemic shock associated with liver failure. Autopsy revealed HCC metastatic to the lungs and right pleura and 21 of bloody pleural effusion in the right side. The cut surface of the metastatic nodule in the right pleura was filled with coagulated blood and necrotic tissue. We concluded that the pleural metastasis had ruptured and caused the right hemothorax. We discuss reported cases of HCC complicated by hemothorax.

Carcinoma, Hepatocellular↗