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PubMed2003

[Hemothorax as complication of laparoscopic technique].

A 69-year-old woman with a hiatal hernia and esophagitis caused by reflux was scheduled for laparoscopic Nissen fundoplication. Anesthetic induction was accomplished with fentanyl, propofol and rocuronium and maintenance with sevoflurane and rocoronium. Hemodynamics were stable until the end of surgery, when a sudden decrease in blood pressure to 40/20 mm Hg and arterial carbon dioxide tension to 14 mm Hg were observed. Anesthetic insufflation was stopped and physiological saline solution and ephedrine were administered. Hemothorax and air embolism were ruled out. After hemodynamic recovery, renewal of anesthetic insufflation was contraindicated, laparoscopy was halted, and hemoperitoneum was ruled out. After extubation, the patient was transferred to the recovery room, where hemodynamic instability worsened progressively. A chest radiograph suggest left hemothorax and an emergency thoracotomy was performed. After evacuation of multiple clots from the pleural cavity, the point of hemorrhage was located at the right crus of the diaphragm and bleeding was arrested. Postoperative recovery continued with no further events. The most common complications of laparoscopy are pneumothorax, gastroesophageal perforation and hemorrhage. However, given the complexity of the technique, the possibility of bleeding in the pleural cavity, as occurred in this case, should be considered. This case highlights the importance of rigorous intraoperative monitoring and postoperative surveillance by the anesthesiologist.

Aged↗
PubMed2003

[A rare case of hemothorax due to rupture of an arteriovenous fistula: successful treatment by enucleation].

Hemothorax due to a rupture in an arteriovenous fistula is rare. We report a case in a 26-year-old woman who presented with continuous right chest pain. On admission, chest radiography revealed a nodular shadow in the right lower lung field with right pleural effusion. The pleural effusion aspirated was blood, suggesting a hemothorax due to the rupture of a pulmonary arteriovenous fistula. The shunt between A 8 and V 8 was confirmed in pulmonary arteriograms. A photomicrograph of the resected specimen showed a dilated arteriovenous fistula, part of whose inner wall was abnormally thin. The pleural wall surrounding the fistula was hypertrophic in parts, suggesting possible repetitive inflammation related with the rupture. Although transcatheter embolization is useful in the treatment of arteriovenous fistulae, it is technically difficult, and cases of fatal complications have been reported. While surgical resection is the most reliable treatment available, the present patient was already at high risk of dying. Accordingly, we chose to perform enucleation, and this was successful.

Adult↗
PubMed1992

[Delayed hemothorax after chest injuries. Report of 31 cases].

Thirty-one patients with delayed hemothorax were treated. The time from trauma to hemothorax formation ranged from 2 to 30 days. The patients with chest injuries accompanied by multiple rib fracture, potential vascular injuries and foreign body retention the thoracic cavity were observed closely. The diagnosis, pathogenesis and treatment were discussed.

Adult↗
PubMed2005

Prevalence of delayed hemothorax in blunt thoracic trauma.

Delayed hemothorax (DHTX) is rarely seen. On an 8-year retrospective analysis of blunt thoracic trauma (BTT), hemothorax (HTX) was diagnosed in 167 patients: 18 children, 113 adults, and 36 elderly. No statistical differences were seen in any age groups regarding Injury Severity Score (mean ISS, 30.54), critical care length of stay (CLOS, 9.0), and hospital LOS (HLOS, 11.21). Mortality rate was 18 per cent in adults and 28 per cent in elderly (P value < 0.0001). HTX was acute in 160 and delayed in 7 patients. Two-thirds of HTX patients were males and 75 per cent had rib fractures. All of our DHTX patients were males (5 adults and 2 elderly) and had rib fractures. Acute HTX was seen in younger patients (43.3 vs 56.1 years, P value 0.46), with higher ISS (31.44 vs 14.43, P value < 0.001), CLOS (7.19 vs 3.0 days, P value 0.511) and HLOS (11.9 vs 11.6, P value 0.468). Mortality was 22.5 per cent in AHTX and none in DHTX. Eighty-six per cent of DHTX and 49 per cent of AHTX patients went home on discharge. DHTX was rare (5%) in the current report with lower ISS, HLOS, and no mortality. Patients with rib fractures should be watched for development of DHTX as timely diagnosis and treatment is essential for favorable outcome.

Adolescent↗
PubMed1991

[Massive hemothorax: an exceptional complication of Rendu-Osler-Weber disease].

Hereditary familial telangiectasis is a vascular dysplasia characterized by a triple syndrome: hereditary character, telangiectasias and hemorrhages. Its association with systemic and/or pulmonary arterio-venous fistulae is frequent and can condition several complications: cerebral abscess, digestive hemorrhages, epistaxis, hemoptysis, hypoxemia, polyglobulia, and rarely the appearance of hemothorax. We describe a patient who was admitted in hospital with a hypovolemic shock secondary to a massive hemothorax; during emergency surgery, which was necessary to perform, a pulmonary A-V fistula was observed in the middle lobe. The studies afterwards performed demonstrated that it was a Rendu-Osler-Weber disease with duodenal, hepatic, and cerebral involvement.

Adult↗
PubMed1985

Effect of hemothorax on experimental empyema thoracis in the guinea pig.

An experimental model for empyema thoracis in the Duncan-Harley guinea pig is introduced. Empyema thoracis development and early death (less than 14 days after bacterial inoculation) were noted after various concentrations and species were inoculated into the pleural space with a piece of umbilical tape, which was used as a cofactor. The effect of concomitant hemothorax was also tested. Group I (N = 90) had intrapleural inoculation of umbilical tape and various concentrations (10(4), 10(6), 10(8) organisms/ml) of various bacterial species, which included Staphylococcus aureus (N = 30), Escherichia coli (N = 30), and Bacteroides fragilis (N = 30). Group II (N = 90) had intrapleural inoculation of umbilical tape, 1 ml of autologous blood, and the same varying concentrations and species of bacteria as Group I. The observation period was 14 days, during which time early deaths were noted. Fifty-eight percent of the staphylococcal group of animals, 37% of the E. coli group of animals, and none of the B. fragilis group of animals developed empyema. Animals with empyema developed significant weight loss (p less than 0.05) and roentgenographic evidence of empyema, which was supported by postmortem pleural reaction and pneumonia scores (p less than 0.05). Higher concentrations of inoculated bacteria produced a higher incidence of empyema in the S. aureus and E. coli groups (p less than 0.05), but concomitant hemothorax did not increase the already high incidence of empyema and early death in the E. coli group. Empyema caused by B. fragilis did not develop, even with cofactors of umbilical tape and blood. Anaerobic infections in this model may require the presence of other aerobic or facultative organisms, the presence of necrotic lung, prior malnutrition, or a combination thereof.

Animals↗
PubMed1981

[Local fibrinolytic therapy with terrilytin in coagulated hemothorax and pleural empyema].

On the basis of experimental and laboratory investigations high fibrinolytic effect of the home proteolytic enzyme terrilythin and the absence of general toxic reactions after intrapleural administration of the drug have been proved. The article describes results of clinical results of clinical tests of the effectiveness of terrilythin in coagulated hemothorax after traumas of the chest and operations on the lungs and in 55 patients with acute pro-fibrinous pleurisy. The successful preventive sanitation was performed in 43 of 50 patients with coagulated hemothorax and initial symptoms of the infectious process as well at the development of pleural empyema were averted.

Administration, Topical↗
PubMed1978

Pancreatic pseudocyst presenting as massive hemothorax: a case report.

The case of a 36-year old man who presented with massive recurrent hemothorax as a complication of a pancreatic pseudocyst is described. Some of the complications of pancreatitis and pancreatic pseudocysts are discussed. Recurrent hemothorax represents an unusual pulmonary complication of pancreatic pseudocysts to be included in the differential diagnosis of pleural fluid collections in pancreatitis.

Acute Disease↗
PubMed1995

[A case of hemothorax occurred two months after graft replacement of descending thoracic aorta with Hemashield arterial prosthesis].

A 70-year-old man performed graft replacement of descending thoracic aorta for chronic aortic dissection (DeBakey IIIb) with Hemashield arterial prosthesis. He also had coronary artery disease (LAD seg. 7.99% stenosis) and he had received PTCA prior to operation. He was administered anticoagulants such as Aspirin and Warfarin postoperatively. Two months after operation, he complained dyspnea and came back to our hospital. Chest X-ray showed left hemothorax. CT scan and aortogram could not revealed bleeding points such as pseudoanerysm at anastomosis site nor new dissection. He recovered after discontinued anticoagulants and drainage. If you need to use the anticoagulants after graft replacement with Hemashield, you should administer the anticoagulants about 14 days after operation. This is the first clinical report that hemothorax occurred two months after graft replacement with Hemashield.

Aged↗
PubMed1993

[The treatment of posttraumatic hemothorax].

A high procoagulative activity of monocytes, a low procoagulative activity of pulmonary macrophages, and decreased proteolytic activity of leukocytes and monocytes are predominant in patients with coagulated hemothorax. The proteolytic activity of leukocytes of the pleural exudate was higher in these patients than in their blood leukocytes and lower than that of blood leukocytes from healthy donors. Differential correction of phagocytic functional activity in the pleural exudate in terms of the type of hemothorax, its stage, procoagulative and proteolytic activities of phagocytes improve the outcome of the disease.

Adolescent↗
PubMed1996

Hepatocellular carcinoma with pleural metastasis complicated by hemothorax.

Hemothorax can be caused by rupture of hepatocellular carcinoma (HCC). Hemoperitoneum is a well-known cause of death caused by rupture of a primary HCC lesion. Rupture of a HCC metastasis has not been adequately described. This is the first report of a HCC patient who died of hemothorax due to rupture of a pleural metastasis. The patient, a woman, died in respiratory failure 2 wk after rupture of her HCC metastasis in the pleura. Autopsy revealed moderately differentiated HCC in the liver, lung, and pleura. We discuss treatment options for ruptured pleura-based HCC metastases.

Adult↗
PubMed1998

Massive spontaneous hemothorax as a presenting sign of aneurysmal rupture of the internal thoracic artery. A case report.

Massive spontaneous hemothorax is a very uncommon, life-threatening situation. Acute dissection and ruptured aorta can be one of the differential diagnoses, but usually the clinical feature is completely different, and very few patients have survived this event and received medical attention. Among other causes of spontaneous bleeding, some are extremely rare, demanding precise diagnosis and judicial and immediate intervention. We describe a patient who presented with a massive hemothorax. There was no immediately apparent cause. Emergent angiography revealed active bleeding from an extremely unusual source: aneurysmal dilatation of the internal thoracic artery.

Adult↗
PubMed1984

Fatal hemothorax caused by a subclavian hemodialysis catheter. Thoughts on prevention.

A 19-year-old woman died when a subclavian catheter that had provided vascular access for plasmapheresis penetrated her right atrium, pericardium, and parietal pleural, causing a hemothorax. Precautions are recommended to minimize the risk of this complication in patients in whom subclavian catheters are used as a vascular access route for hemodialysis or plasmapheresis.

Adult↗
PubMed1980

Hemothorax in the newborn.

Twenty cases of hemothorax in newborns, including 4 of our own patients, are reviewed in detail. This unusual cause of acute respiratory distress within the neonatal period was observed in 14 males and 6 females. Most of the patients were fullterm newborns. As causal factors hemorrhagic disease of the newborn (vitamin K deficiency), disseminated intravascular coagulation, arteriovenous malformations and pleural/vascular rupture are considered. The time of occurrence of bleeding symptoms ranged from 1 to 28 days of life. Sixteen out of 20 patients survived without sequelae, but in 4 cases the outcome was lethal.

Adult↗
PubMedDate not supplied

CT diagnosis of right hemothorax secondary to ruptured thoracoabdominal aneurysm: case report.

The development of a right hemothorax as the result of a ruptured thoracoabdominal aneurysm is an uncommon and usually fatal event. Survival depends upon an accurate diagnosis and prompt surgical intervention. We present a case of a ruptured thoracoabdominal aneurysm into the right chest that presented as opacification of the right hemithorax and hypotension. An early CT scan provided the correct preoperative diagnosis, although the patient did not survive.

Aged↗
PubMed2003

Spontaneous thymic cyst hemorrhage causing hemothorax.

The case describes a 56-year-old man who had thymic cyst hemorrhage, followed by right hemothorax. There was a high possibility that his accompanying disease, an alteration in hemostasis due to alcoholic liver cirrhosis and hypertension, would induce thymic cyst hemorrhage. Thymic cyst hemorrhage should be included in possible causes of the sudden onset of mediastinal or intrathoracic hemorrhage, in addition to the rupture of aortic aneurysm or malignant mediastinal tumor.

Hemorrhage↗
PubMed1999

Hemothorax under thrombolytic therapy with recombinant tissue: plasminogen activator (rt-PA) in a 16-year-old girl.

We present the case of a 16-year-old girl with an extended thrombosis of the femoral and iliac vein and the inferior vena cava during pleuropneumonia; predisposing risk factors for thrombophilia were: use of contraceptives, nicotine abuse and congenital deficiency of antithrombin III (not previously diagnosed). Thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA; initial dose: 0.08 mg/kg/h) was started. 2 days later--after diagnosis of an extended hemothorax: 1500 ml blood were obtained after thoracocentesis, transfusion of packed red blood cells was necessary--rt-PA was stopped, with only heparin (400 U/kg/d) being administered. 36 h later--the thrombosis had not yet changed--the thrombolytic therapy with rt-PA was continued in a markedly reduced dose (0.015 mg/kg/d) with no further bleeding complications. 8 days later--after successful thrombolysis--t-PA was stopped, heparin was given for another 10 days, then cumarin was administered orally.

Adolescent↗