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At least 19 recordsLinked to original sources
PubMed2005

Spontaneous hemopneumothorax revisited: clinical approach and systemic review of the literature.

BACKGROUND: Spontaneous hemopneumothorax, defined as the accumulation of more than 400 mL of blood in the pleural cavity in association with spontaneous pneumothorax, is a rare entity occurring in young patients and may be life threatening. Although many reports of case studies and series have been published in the world literature, the lack of consistent intraoperative findings and varying surgical methods require a review study. METHODS: We discuss the clinical features, management, surgical findings, and outcomes of our own patients with spontaneous hemopneumothorax. RESULTS: From September 1997 to September 2003, 488 patients with spontaneous pneumothorax were treated at our hospital. Of these patients, 27 (5.5%) had spontaneous hemopneumothorax develop. These 27 patients were comprised of 25 men and 2 women ranging in age from 15 to 39 years (mean age, 22.3 years). The amount of blood that was drained ranged from 400 to 1,700 mL (mean, 1,012 mL). Twenty-one patients underwent video-assisted thoracoscopic surgery within 1 day after admission; the remaining 6 patients were treated conservatively with tube thoracostomy alone. On arrival at our emergency room, 9 patients (33.3%) experienced hemodynamic instability with hypovolemic shock. In a review of 6,396 patients with spontaneous pneumothorax in the literature and in our current study, 201 patients (3.1%) had spontaneous hemopneumothorax develop. One hundred seventy-six patients (87.6%) were treated surgically, whereas video-assisted thoracoscopic surgery has been performed in 48.9% of patients (86 of 176). There was no recurrence of hemopneumothorax in any of the 201 patients with spontaneous hemopneumothorax after treatment during the follow-up period. CONCLUSIONS: Thus one-third of the patients with spontaneous hemopneumothorax had shock symptoms develop. Video-assisted thoracoscopic surgery may be considered as an initial treatment procedure for patients with spontaneous hemopneumothorax, whereas conservative treatment is effective and may be performed in selected patients.

Adolescent↗
PubMed1995

[The effect of performance of diagnostic and therapeutic procedures on successful treatment of hemopneumothorax in isolated thoracic trauma].

Influence of performed diagnostic and therapeutic procedures on the outcome of the treatment of traumatic hemopneumothorax during isolated chest trauma. The aim of this study is the assessment of the influence of performed diagnostic and therapeutic procedures on the outcome of hemopneumothorax as a part of isolated chest trauma. The main group consists of 51 patients with hemopneumothorax. Patients with pneumothorax without effusion represent the first control group; the second control group consist of patients treated because of iatrogenic pneumothorax. In the main and control groups the analysis of clinical, roentgenographic and functional parameters was made, together with the analysis of particular therapeutic procedures, the estimation of the success of the treatment was based on roentgenographic and functional parameters. The higher incidence of hemopneumothorax compared with control groups during chest trauma in the analyzed material is statistically significant. The occurrence of bilateral hemopneumothorax in 10% of cases emphasizes the need of adequate roentgenographic assessment of injured patients. Regardless of the intensity of the trauma, symptoms do not always indicate the existence of hemopneumothorax. The number of fractured ribs is not of significant importance in terms of the occurrence of hemopneumothorax or pneumothorax. Severe dyspnea can be accompanied even with a smaller collapse of the lung independently of the amount of blood in the pleural cavity. Oxygenation in the arterial blood is impaired with the great and small pulmonary collapse. Hemodynamic disorders existed in 14% all cases. The higher frequency of operative treatment in the main group is statistically significant. The majority of cases of traumatic hemopneumothorax can be successfully treated by the conservative treatment. Accompanying complications do not have greater influence on the outcome.

Adult↗
PubMed1997

Hemopneumothorax missed by auscultation in penetrating chest injury.

OBJECTIVE: To determine the frequency and extent of hemothorax, pneumothorax, and hemopneumothorax missed by auscultation in penetrating chest injury. DESIGN: A retrospective chart and chest radiograph review. MATERIALS AND METHODS: One hundred and eighteen patients suffering penetrating chest injuries during 1993 were studied. A missed auscultation was defined as a patient with normal breath sounds but shown by chest radiograph to have a hemothorax, pneumothorax, or hemopneumothorax. The amount of hemothorax was recorded after chest tube placement or at thoracotomy. The degree of pneumothorax was determined by Rhea's method. RESULTS: Seventy-one patients (60%) had a hemothorax, pneumothorax, or hemopneumothorax. Auscultation to detect hemothorax, pneumothorax, or hemopneumothorax had a sensitivity of 58%, a specificity of 98%, and a positive predictive value of 98%. Thirty of 71 patients (42%) were found to have pleural space blood or air missed by auscultation. Twelve patients (41%) had a hemopneumothorax, 11 patients (36%) had hemothorax, and seven patients (23%) had pneumothorax. Auscultation missed hemothorax up to 600 mL, pneumothorax up to 28%, and hemopneumothorax up to 800 mL and 28%. CONCLUSION: Hemopneumothorax and hemothorax are the conditions most likely to be missed by auscultation, especially in patients with gunshot wounds. Auscultation has a high positive predictive value because it indicates injury with a fair degree of certainty; however, a negative auscultation does not rule out injury.

Adolescent↗
PubMed2006

Spontaneous hemopneumothorax in children: case report and review of literature.

Spontaneous hemopneumothorax is rare, occurs in young adolescents, and can be life threatening secondary to massive bleeding. An adolescent with spontaneous hemopneumothorax and shock managed by tube thorascostomy is described here. We compared our case with published data of spontaneous hemopneumothorax in the pediatric age group. Spontaneous hemopneumothorax involves the accumulation of air and blood in the pleural space in the absence of trauma or other obvious causes. Spontaneous hemopneumothorax is usually seen in adolescents, more common in males than females. The common clinical features of spontaneous hemopneumothorax include dyspnoea and chest pain, and 30% present with hypovolemic shock. The bleeding can result from a torn adhesion between the parietal and visceral pleurae, from a rupture of vascularized bullae, or from torn congenital aberrant vessels. Over the last 6 decades, the treatment has progressed from the thoracotomy to minimally invasive techniques such as video assisted thoracoscopic surgery, with great reduction in mortality and recurrence rates. Although a rare entity, diagnosis of spontaneous hemopneumothorax must be considered in young adolescents presenting with spontaneous onset of chest pain and dyspnoea with radiograph findings of hydropneumothorax and/or signs of shock.

Adolescent↗
PubMed2003

Minithoracotomy with simultaneous video-assisted thoracoscopic surgery vs. video-assisted thoracoscopic surgery for spontaneous hemopneumothorax.

BACKGROUND: Spontaneous hemopneumothorax, a life-threatening and rare disorder and complication of primary spontaneous pneumothorax, is regarded as a surgical emergency. We have prospectively investigated the differences in safety and utility between minithoracotomy with simultaneous video-assisted thoracoscopic surgery (MT + VATS) and the video-assisted thoracoscopic surgery approach (VATS) in the treatment of spontaneous hemopneumothorax. METHODS: From Jan 1998 to May 2002, 248 patients with primary spontaneous pneumothorax were treated in our hospital. Among these patients, 12 (4.8 %) spontaneous hemopneumothorax occurred, all in the first episode of spontaneous pneumothorax. After tube thoracostomy, the amount of blood drainage ranged from 500 to 1,500 ml. 8 patients were treated by MT + VATS and 4 by VATS. RESULTS: During surgery, the sources of hemorrhage were all from the torn aberrant vessels between the apical blebs and the parietal pleura. The duration of main surgical procedure (including removal of blood clot in pleural cavity, control of bleeding and blebectomy) was significantly shorter in MT + VATS than in VATS (p < 0.01, Mann-Whitney U). There were no differences between these two groups in postoperative chest tube drainage duration, average postoperative pain score or hospital stay. No relapses occurred in the succeeding 6 months to 4 years. CONCLUSIONS: Spontaneous hemopneumothorax is usually treated as an urgent surgical condition. MT + VATS is an easy accessible and safe procedure that could be applied as an initial treatment method in the patient with spontaneous hemopneumothorax, especially in the treatment of the patients with active hemorrhage and massive blood clot in the thorax.

Adult↗
PubMed2006

Spontaneous hemopneumothorax.

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.

Hemopneumothorax↗
PubMed1990

[Four cases of spontaneous hemopneumothorax].

We reported four cases of spontaneous hemopneumothorax. Of these, one (a 25-year-old man) had right hemopneumothorax and three (a 28-year-old man, a 21-year-old woman and a 24-year-old man) had left hemopneumothorax. In one case, because massive intrapleural bleeding had continued, an emergency operation was performed. In two cases, thoracotomy was performed because of recurrent pneumothorax. In the other case, about one week after hemopneumothorax had been controlled by pleural drainage, pneumothorax recurred and thoracotomy was performed. In conclusion, early thoracotomy is the best treatment for spontaneous hemopneumothorax.

Adult↗
PubMed1998

Video-assisted thoracoscopic surgery for spontaneous hemopneumothorax.

We operated on 403 patients with spontaneous pneumothorax between 1992 and 1996. Among these cases, 11 (2.7%) were spontaneous hemopneumothorax. The patients were all men, with ages ranging from 19 to 28 years (mean 23.8 years). The amount of blood drainage ranged from 650 to 2300 ml. Video-assisted thoracoscopic surgery was performed on these patients within 1 day after admission. The sources of bleeding were in the parietal and visceral pleurae of ruptured bullae (n = 6), the parietal pleura (n = 4), or the visceral pleura (n = 1). During operation, the ruptured bullae can be managed by an endoscopic linear stapler for a bullectomy, and the bleeding parietal pleura of the torn adhesion can be coagulated directly. Postoperative recovery of the 11 patients was uneventful, and they were discharged 4 to 10 days after the operation. No recurrence of spontaneous hemopneumothorax or any other complications occurred during follow-up. Thus spontaneous hemopneumothorax can be readily managed by cauterizing a bleeding site where appropriate, excising the apicocystic disease, and pleurodesis. As a minimally invasive method, video-assisted thoracoscopic surgery may be considered an initial treatment procedure in patients with spontaneous hemopneumothorax.

Adult↗
PubMed2005

Spontaneous hemopneumothorax: is conservative treatment enough?

PURPOSE: Spontaneous hemopneumothorax is a rare disorder, occurring in 1% to 12% of patients with spontaneous pneumothorax. The present review was undertaken to emphasize the potential life-threatening condition of spontaneous hemopneumothorax and reassess the benefit of conservative treatment with chest tube drainage. MATERIAL AND METHODS: From 1997 to 2002, 291 cases of spontaneous pneumothorax were treated in our department. Of these, 9 (3.09%) developed hemopneumothorax (> 400 ml). The clinical features of these patients and the results of conservative and surgical management were retrospectively reviewed. RESULTS: Seven patients were treated conservatively and two required VATS and thoracotomy because of worsening clinical condition. The amount of aspirated blood ranged from 400 to 3700 ml (mean, 1533 ml). Six patients received a homologous blood transfusion. CONCLUSIONS: In conclusion, hemopneumothorax is a serious condition complicating spontaneous pneumothorax. Conservative treatment is adequate in most cases and should be performed if bleeding persists for less than 24 hours after chest tube placement.

Chest Tubes↗
PubMed1998

[Video-assisted thoracoscopic surgery in spontaneous hemopneumothorax].

We retrospectively studied the safety and utility of video-assisted thoracoscopic surgery (VATS) in the treatment of spontaneous hemopneumothorax. Of 128 cases of spontaneous pneumothorax operated on our hospital from April 1988 to October 1997, hemopneumothorax developed in 8 cases (2 cases treated by thoracotomy and 6 by VATS). In all 8 cases, bleeding points and pulmonary bullae were easily found and hemostasis and resection of pulmonary bullae conducted quickly and safely. Two cases of VATS involved elective surgery. Of surgical emergent cases, the duration from visit our hospital to operation and surgical duration in VATS were almost as long as those in thoracotomy. The mean duration of postoperative chest drainage and postoperative hospital stay in VAST were less than in thoracotomy except for a VAST case with persistent air leakage. Blood loss from onset to operation and blood transfusion for VATS were almost equal to thoracotomy. Postoperative duration of analgesic use for VATS were shorter than that for thoracotomy. The VATS case with persistent air leakage should be necessary to reinforce the pulmonary stapled line or to convert to thoracotomy. In all cases, residual hematoma was found in the thoracic cavity. We conclude that early surgical repair should be performed once spontaneous hemopneumothorax is diagnosed and confirmed, and that VATS may be the first choice of surgery because it provides a better view and more facilitated manipulation during surgery than thoracotomy, and is a safe, nonaggressive therapeutic option.

Adult↗
PubMed2002

Thoracoscopic treatment for spontaneous hemopneumothorax.

Spontaneous hemopneumothorax is a rare clinical entity sometimes requiring an operation in the early stage. Two patients who underwent successful video-assisted thoracic surgery (VATS) for spontaneous hemopneumothorax are presented. In both cases, the bleeding point was clearly identified, and hemostasis was easily obtained by clipping the point and placing three access ports in the usual fashion. Furthermore, the evacuation of clotted blood and resection of bulla were performed with no difficulties. The postoperative courses were smooth, and no complications occurred, although the preoperative general condition in the second case was hemodynamically unstable. The advantages of VATS over conventional thoracotomy include less time required to access the pleural cavity, a better view, and more facilitated manipulation during surgery. Because spontaneous hemopneumothorax is a benign disease, VATS should be considered an initial treatment option in all patients with this condition, even those with active bleeding.

Adult↗
PubMed1996

Spontaneous hemopneumothorax.

BACKGROUND: Spontaneous hemopneumothorax is a rare disorder, occurring in 1% to 12% of patients with spontaneous pneumothorax. We studied our previously treated patients to determine the nature of optimal operative management. METHODS: This was a retrospective case study. From 1987 to 1994, of 428 cases of spontaneous pneumothorax that occurred in 234 patients treated at our institution, hemopneumothorax developed in 10 patients (2.3%). The clinical features of these patients were studied. RESULTS: The amount of bleeding ranged from 600 to 1,600 mL, and 3 patients exhibited symptoms of shock, such as sweating, nausea, and syncope. Six patients underwent operation within 7 days from the onset, and this involved resection of the bullae or pneumorrhaphy, or both. The source of bleeding was identified in 5 patients. Pathologic examination showed marked fibrosis with alcian blue-positive deposits of aberrant vessels. All 6 patients continue to be well postoperatively without recurrence or complications. Four patients did not undergo early thoracotomy. However, decortication was required in 3 of these patients because of a reactive fluid collection in the pleural space, which led to impaired lung expansion. CONCLUSIONS: Early surgical repair should be considered once diagnosis of a spontaneous hemopneumothorax is confirmed, because this provides better long-term results. Video-assisted thoracoscopic surgery as well as minithoracotomy should be considered as surgical options because of the improved quality of life they confer.

Adolescent↗
PubMed2003

Spontaneous hemopneumothorax: an overlooked life-threatening condition.

Spontaneous hemopneumothorax is a rare clinical entity. A large spontaneous hemopneumothorax is life-threatening, and mortality increases with delayed recognition and intervention. The initial chest radiography and the amount of blood drained from the inserted chest tube frequently underestimates the actual blood loss from the active bleeder around the ruptured apical bullae, leading to failed recognition of a potentially life-threatening condition until unexpected hemodynamic collapse develops. We report 2 cases of spontaneous hemopneumothorax to emphasize the importance of early recognition and prompt surgical intervention by video-assisted thoracoscopic surgery (VATS).

Adult↗
PubMed2000

Spontaneous hemopneumothorax--results of conservative treatment.

Spontaneous hemopneumothorax is a serious condition complicating spontaneous pneumothorax. Early stage thoracotomy has been advocated to stop the bleeding and evacuate the coagulated blood from the pleural cavity. The present review was undertaken to emphasize the potential life-threatening condition of spontaneous hemopneumothorax and reassess the benefit of conservative treatment with chest tube drainage. Out of six patients, five patients were treated conservatively and one required an emergency thoracotomy because of cardiovascular collapse. Although three patients still had minimal residual hemopneumothorax on discharge, none of them developed empyema or trapped lung. In conclusion, conservative treatment is efficient and should be performed if bleeding persists for less than 24 hours after chest tube placement.

Adult↗
PubMed1990

Loculated hemopneumothorax of a major fissure in patients with COPD and associated pleural disease.

Two patients with underlying COPD and bullous changes of the lungs were found to have a loculated hemopneumothorax within a major fissure by computed tomography. Both patients had associated pleural disease. In one of the patients, the hemopneumothorax was believed to be potentially compromising pulmonary function. Percutaneous needle drainage of the loculated hemopneumothoraces resulted in large symptomatic pneumothoraces requiring urgent insertion of closed thoracostomy tubes. Loculated hemopneumothorax is an unusual finding within a major fissure mimicking pulmonary abscess, infected bullae, pulmonary cyst, or a cavitary carcinoma of the lung. Physicians treating patients with COPD and associated pleural disease should be aware of this rare condition, since percutaneous needle drainage may be associated with serious life-threatening complications.

Hemopneumothorax↗
PubMed2000

Spontaneous hemopneumothorax in women.

Spontaneous hemopneumothorax is uncommon, especially among women. We report a case of spontaneous hemopneumothorax in a 19-year-old woman and review seven other cases of spontaneous hemopneumothorax in women that have been reported in the English language.

Adult↗
PubMedDate not supplied

Hemopneumothorax due to pulmonary metastasis with malignant hemangioendothelioma: CT and pathological findings.

Malignant hemangioendothelioma is a rare vascular tumor. The disease frequently recurs and eventually metastasizes to the lung in most cases. Hemopneumothorax developing soon after metastasis to the lung indicates on unfavorable prognosis. We had an opportunity to examine a patient who had malignant hemangioendothelioma in the occipital scalp and developed hemopneumothorax following metastasis to the lung. We report the computed tomographic (CT) and pathological finding in the patient, and review the literature on hemopneumothorax.

Adult↗
PubMed1995

[Treatment and etiology of spontaneous hemopneumothorax].

The incidence of spontaneous hemopneumothorax is reported to be 1-12% of all cases of spontaneous pneumothorax. We treated 152 cases of spontaneous pneumothorax in the past 8 years and hemopneumothorax occurred in 4 cases which is 2.6% of all cases of spontaneous pneumothorax. All the patients were male and the age ranged from 17 to 30. The total amount of blood loss ranged from 1,200-3,200 mliters and surgical treatment was carried out within 2 days after admission. The bleeding point was visceral pleura of raptured bulla in 2 cases, parietal pleura of the torn adhesion in 1 case, and both visceral and parietal pleura in 1 case. Postoperative course was satisfactory and discharged within 2 weeks after admission in all cases. The authors concluded that early thoracotomy is recommended for spontaneous hemopneumothorax.

Adolescent↗