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PubMed2005

Dissection and rupture of the left subclavian artery presenting as hemothorax in a patient with von Recklinghausen's disease.

Hemothorax is a rare and life-threatening complication of von Recklinghausen's disease. We present a case of a 48-year-old man with this disease who developed hemothorax caused by rupture of a left subclavian artery dissection. To our knowledge, the case presented here is the first to describe successful surgical management--graft replacement of the left subclavian artery--in hemothorax due to arterial dissection associated with von Recklinghausen's disease.

Aortic Dissection↗
PubMed1995

Spontaneous hemothorax caused by a chest wall chondrosarcoma.

A 48-year-old man who presented with chest pain was found to have a spontaneous hemothorax caused by a large grade II chondrosarcoma. This was diagnosed on the basis of the findings from thoracotomy. After chest tube drainage of the hemothorax, the tissue obtained by two computed tomography-guided biopsies of a residual mass did not yield findings that allowed diagnosis of the tumor. This unusual case illustrates the importance of a systematic workup whenever a spontaneous hemothorax is encountered.

Bone Neoplasms↗
PubMed1978

Acute traumatic hemothorax.

Over the past 5 years, 107 patients have been evaluated for acute traumatic hemothorax at the University of Kentucky Medical Center. Immediate tube thoracostomy was performed on 90 patients for evacuation of blood and air. Only 2 patients died. Thoracotomy was performed as part of the initial therapy in 9 patients. Thoracotomy for continued hemorrhage from a pulmonary parenchymal injury was required in 3 patients from the entire group. Thoracentesis or observation was the initial therapy for limited hemothorax in 8 stable patients. Three of these patients subsequently required tube thoracostomy 2 to 23 days following injury due to expanding effusions, and 1 patient required multiple thoracotomies for sepsis, fibrothorax, and empyema. These observations indicate that early evacuation of blood by means of a tube thoracostomy is essential to minimize morbidity in acute traumatic hemothorax. If continuing hemorrhage after tube thoracostomy occurs, there is a higher association of injury to additional vital structures.

Abdominal Injuries↗
PubMed2006

Hemothorax due to metastatic hepatocellular carcinoma presenting with massive hemoptysis.

Hemoperitoneum caused by ruptured hepatocellular carcinoma (HCC) is not uncommon in patients with HCC. Hemothorax due to rupture of metastatic HCC, however, is a very rare complication with high mortality because of uncontrollable hemorrhage. We describe a 42-year-old male HCC patient with chest wall metastasis complicated by hemothorax with an unusual presentation of massive hemoptysis. He received tube thoracotomy immediately and emergency surgery because of persistent bleeding. Hemostasis was achieved transiently. Despite intensive care, he died of multiple organ failure on the 6th postoperative day. We conclude that hemothorax due to a ruptured HCC, as in this case, indicates a very poor prognosis despite intensive treatment.

Adult↗
PubMed2006

Successful treatment of intractable hemothorax with recombinant factor VIIa in a nonhemophilic patient.

Recombinant factor VIIa (rFVIIa) was developed for the treatment of bleeding in hemophilic patients with inhibitors. It has also been used to stop bleeding in nonhemophilic patients who fail to respond to conventional treatment. We report a case of catastrophic hemothorax in which bleeding was stopped by administration of rFVIIa. A 68-year-old woman with chronic hepatitis C-related liver cirrhosis was admitted due to pneumonia and parapneumonic effusion. The patient developed hemothorax and hypovolemic shock after thoracentesis. Conventional therapies including tube thoracostomy and transarterial embolization failed to stop the life-threatening bleeding. The bleeding stopped after administration of rFVIIa 100 microg/kg/BW at 2-hour intervals for a total of two doses on the 3rd day of hospitalization. Despite intensive care, however, the patient died due to nosocomial infection and multiple organ failure on the 12th day of hospitalization. Hemothorax in a nonhemophilic patient can be successfully treated with rFVIIa.

Aged↗
PubMed1996

Recurrent massive hemothorax in Rendu-Osler-Weber syndrome.

We report a case of Rendu-Osler-Weber syndrome, occurring as sudden death after two episodes of massive hemothorax. Autopsy revealed massive hemothorax resulting from spontaneous rupture of one of three subpleural arteriovenous malformations. Review of the patient's hospital records showed that she had had a massive spontaneous hemothorax 13 years earlier that was managed conservatively. This case emphasizes the importance of early therapeutic (surgical or radiologic) intervention in the treatment of pulmonary arteriovenous malformations.

Arteriovenous Malformations↗
PubMed1998

Thoracoscopy in the management of hemothorax and retained blood after trauma.

Retained hemothorax complicated by blood clotting in the thoracic cavity traditionally has been treated with open thoracotomy for evacuation of the hemothorax and cleaning of the thoracic cavity. Recent improvements in video technology and endoscopic surgical instruments have fostered renewed interest in video-assisted thoracoscopic surgery to diagnose and treat a variety of surgical conditions of the chest, which classically were managed exclusively by thoracotomy. Posttraumatic retained hemothorax currently is being managed at most institutions by video-assisted thoracoscopic surgery, with consistently good results.

Female↗
PubMed2005

Misplacement of central vein catheters in patients with hemothorax: a new approach to resolve the problem.

BACKGROUND: In emergency and pre-hospital care, the verification of the correct position of a central venous catheter is based on the observation of blood color reflow as well as pressure changes with respiration. However, in trauma patient with hemothorax, these indices may not always be reliable signs as the catheter is in a blood-filled pleural space. METHODS: A review of reports published describing patients presenting hemothorax and equipped with central venous catheter wrongly assumed to be in the correct position was performed. RESULTS: Over 10 years, seven reports have been published and a last study was found in the references list of one of the reviews. CONCLUSION: In patients with hemothorax due to severe thoracic trauma or other causes, a delay in detection of incorrect placement of a central venous catheter may delay fluid resuscitation and decrease the chances of survival. In this situation, the use of portable ultrasound devices may be an useful method to increase success rate in catheter insertion.

Catheterization, Central Venous↗
PubMed1993

Idiopathic hemothorax.

Development of spontaneous hemothorax without predisposing conditions is extremely rare. We report a young man with a history of a seizure disorder who presented to the emergency department with spontaneous hemothorax. Exploratory thoracotomy evacuated 2,000 ml of old blood. No source of hemorrhage was identified. To our knowledge, this is the first report of spontaneous hemothorax proved by thoracotomy.

Adult↗
PubMed1996

Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multicenter trial.

To test the efficacy of intrapleural fibrinolytic therapy in patients with loculated pleural effusions, we conducted an open, prospective, and multicenter trial among five hospitals in Mexico. We enrolled patients with hemothorax or empyema, clotted and/or loculated, that was not resolved through conventional pleural drainage with chest tube and antibiotics in patients with empyema. All patients received repeated doses of 250,000 IU of streptokinase through chest tube. Effectiveness criteria were before and after intrapleural streptokinase (IPSK) drainage, and poststreptokinase radiographic and respiratory function test improvement. Forty-eight patients were studied; there were 30 patients with empyemas, 14 with hemothorax, and 4 patients with malignant pleural effusions without lung trapping. Successful fibrinolysis was obtained in 44 patients, with complete resolution of the pleural collection and adequate radiologic and spirometric improvement. In three of four patients with multiloculated malignant hemothorax with high-yielding pleural drainage, IPSK allowed successful lysis of loci and an adequate pleurodesis was achieved. Only four patients required surgical treatment. The overall success rate in our series was 92%, similar to previous reports. The results in this first prospective and multicentric trial suggest that intrapleural fibrinolysis is an effective and safe adjunctive treatment in patients with heterogeneous pleural coagulated and loculated collections to restore the pulmonary function assessed by respiratory function tests and can obviate surgery in most cases.

Adolescent↗
PubMed1999

Delayed traumatic hemothorax on ticlopidine and aspirin for coronary stent.

A 64-year-old man presented with worsening dyspnea on exertion and hemothorax of the left chest 7 days after discharge from the hospital on ticlopidine and aspirin after coronary stent placement to his left circumflex artery. He had suffered traumatic rib fractures to the seventh, eighth, and ninth left ribs 28 days before this presentation and 21 days before starting the ticlopidine. Results of chest radiography at discharge 7 days earlier while on aspirin and after brief IV heparin had been negative except for minimal atelectasis and rib fractures barely visible on posteroanterior view. The delayed hemothorax had lowered the peripheral blood hematocrit to 23% and required tube thoracostomy drainage and blood transfusion. The delayed traumatic hemothorax in this case occurred on treatment with ticlopidine and did not recur with continuation of aspirin alone.

Aspirin↗
PubMedDate not supplied

[Videothoracoscopy in the diagnosis and treatment of hemothorax].

Video assisted thoracic surgery (VATS) has assumed greater importance in the management of pleural diseases. From 1994 to 1998 the Authors report their experience about 11 cases of hemothoraces depending on various causes: 6 hemothoraces and 3 hemopneumothoraces, some spontaneous or iatrogenic, others in patients with chest trauma; 2 clotted hemothoraces. All patients were studied by VAT detecting the source of bleeding in 6 cases of acute hemothorax and in 3 cases of acute hemopneumothorax; in 5 cases the lesions were successfully repaired with thoracoscopic technique. In others 4 patients the VATS approach was converted to thoracotomy for the seriousness of lesions: 3 acute hemothoraces (1 patient with penetrating thoracic firearms injury, 1 patient with extended lung laceration, 1 patient with iatrogenic lesion of right subclavian artery); 1 acute hemopneumothorax in one patient with penetrating thoracic firearms injury and left hemidiaphragmatic double perforation: in this case laparotomy was also operated in order to exclude others abdominal lesions. 2 cases of clotted hemothorax were operated by VATS performing the removal of clots after their fragmentation by endobabcock and pleural irrigation-aspiration with physiological solution. No procedure related complications were occurred. The authors conclude that the video-thoracoscopic approach is certainly advantageous for the management of spontaneous, traumatic or iatrogenic acute hemothoraces. This technique permits, with minimal traumatism and very little complications, the correct therapeutic programming (VATS operation or conversion to thoracotomy). However some hemothoraces (hemothoraces in patients with serious cranial trauma, with spleen rupture, with great vessels rupture, with heart rupture or with massive post-operating hemothorax) contro-indicate the thoracoscopic treatment: immediate thoracotomy and/or laparotomy, in these cases, is indispensable. In the treatment of clotted hemothoraces the VATS is a favourable alternative to thoracotomy, reforming the pleural cavity with minimal traumatism and avoiding tardive complications.

Adult↗
PubMed2001

[Hemothorax and retroperitoneal bleeding caused by warfarin use in a polytraumatized patient].

If some medical problems are not noticed to in polytraumatized patients at the right time, they may be caused by serious complications. The haematological parameters, especially bleeding and coagulation factors, are very important for them. If they use warfarin, heparin or salicylates, they should be cared intensively. In this paper, a traffic accident case, a 48-year-old woman has been reported. She broke her iliac bone and made her hemothorax. In the first health centre the patient was admitted, Hemothorax was not recognized since chest graphics was not diagnosed at an earlier stage. When dyspnoea was began, pulmonary embolism diagnosis was made and warfarin was applied which caused retroperitoneal bleeding. In fact, it is not known whether hemothorax was caused by the first trauma or by the use of warfarin. In our hospital, with the teamwork of emergency room, thorax surgery, orthopaedics, internal medicine and chest department, correct diagnosis was made and correct treatment was applied, and the patient got out of the hospital in good health. In conclusion, patients with multiple traumas should be followed with a multidisciplinary approach. There are a lot of considerations in the follow-up and treatment of this class of patients. If the traumatized patients are used warfarin, they should be observed more carefully.

Accidents, Traffic↗
PubMed1992

[The treatment of pneumothorax and hemothorax in multiple rib fractures and associated trauma].

The results of treatment of 480 sufferers with multiple costal fractures and associated trauma to the chest were analysed. Resulting from trauma, 55 (25.5%) patients developed pneumothorax, 71 (32.8%)--hemothorax, 90 (41.7%)--hemopneumothorax. Treatment of pneumo- and hemothorax in most cases was conservative (puncture of the pleural cavity was usually performed, rarely--its drainage). In 47 sufferers with associated trauma who were at a forced position (lying on their back), the aimed catheterization of the pleural cavity by means of the trocar stilette curved under the angle of 60 degrees was used. For the treatment of clotted hemothorax, the streptokinase was used with a positive effect noted in 6 of 7 patients. Indications for thoracotomy are restricted in patients with associated chest trauma in presence of shock and acute blood loss.

Hemothorax↗
PubMedDate not supplied

Ruptured thoracic aortic dissection presenting as opacified left hemothorax.

Acute aortic dissections are uncommon, with a reported incidence of 2000 cases per year in the United States. Hemothorax is an unusual but well-described complication of ruptured thoracic aortic dissection. It usually occurs on the left and can be seen in both proximal and distal dissections. Chest radiographs (CXR) in thoracic aortic dissections often reveal a widened mediastinum or abnormal aortic silhouette, evident in 80%-90% of cases. However, CXR may be normal in about 12% of patients with aortic dissection. Clues that would indicate aortic dissection such as abnormal aortic silhouette and widened mediastinum may be obscured by an opacified hemothorax caused by rupture of a thoracic aortic dissection. A high index of suspicion is necessary to make a diagnosis of ruptured thoracic aortic dissection in a patient presenting with hemothorax. This is illustrated in the case described.

Aged↗
PubMed1991

[The role of clinical x-ray studies in posttraumatic coagulated hemothorax].

An examination of 89 patients with posttraumatic coagulated hemothorax has shown that the definite roentgen picture corresponds to the characteristic clinical picture of the disease. These clinico-roentgenological signs of coagulated hemothorax are the determining factors in selection of the rational method of treatment. The data obtained show the necessity of early thoracotomy in cases of coagulated posttraumatic hemothorax.

Hemothorax↗
PubMed1977

[Hemothorax after abdominal vagotomy. Diagnostic problem].

Selective or selective-proximal vagotomy has increased in preference as surgical treatment for uncomplicated duodenal ulcer disease. An unusual immediate complication of transabdominal vagotomy is the hemothorax. Few cases of this complication have been reported in literature. Our case represents a variation with simultaneous presence of a both-sided hemothorax. Although the exact etiology of this complication remains obscure, we try to explain this spontaneous hemothorax by operative injuries of subpleural vessels.

Abdomen↗
PubMed1993

[CT finding of right diaphragmatic rupture due to blunt trauma--subhepatic hemothorax].

Owing to the poor detectability of the anatomic location of diaphragm on the parallel plane of computed tomography (CT), capability of CT to predict traumatic ruptured diaphragm has been debated in several reports. A specific hematoma (subhepatic hemothorax) adjacent to the posterior attachment of the right diaphragm was identified on CT. The finding originated from herniated liver that migrated to the posterior thoracic wall as a result of gravity, to separate the hemothorax in the supine position. This was surgically proven in two patients after blunt traumatic accident. The finding is useful in predicting right diaphragmatic rupture on CT study. The formation of subhepatic hemothorax, its differential diagnosis and a brief review of diaphragmatic rupture are discussed.

Adult↗