Early Video‐Assisted Thoracic Surgery for Primary Spontaneous Hemopneumothorax

Abstract

Our study suggests that surgery should be undertaken for PSHP as soon as possible after the clinical condition has stabilized. Under this strategy, VATS is an acceptable approach. It allows a shorter hospital stay and is exempt from unnecessary blood transfusion. Later complications, such as empyema and impaired lung reexpansion, can also be avoided.

Simultaneous occurrence of ipsilateral primary spontaneous hemopneumothorax and contralateral pneumothorax in an adolescent

“…Some studies have concluded that conservative treatment is adequate if bleeding persists less than 24 hours after chest tube insertion [8]. However, if the patients with PSHP are initially managed nonoperatively, most of them ultimately undergo surgery for one of the following conditions: refractory clinical deterioration (profuse blood loss), reappearance of an unstable condition (rebleeding), and later complications (reactive fluid collection, clot empyema, or persistent air leak) [4]. Recent studies have been concerned with the importance of early and aggressive treatment of PSHP in the stable condition [4,7].…”

“…Unlike other spontaneous hemothorax events caused by malignancy, congenital cystic adenomatoid malformation, or coagulopathy, the mechanisms of bleeding in PSHP are well described [6]. Primary spontaneous hemopneumothorax most commonly results from torn adhesions of the pleura, rupture of vascularized bullae, and torn congenital aberrant vessels between the parietal pleura and bulla [4,6]. Some authors have stated that the peculiarity of PSHP is a sustained hemorrhage resulting from negative intrapleural pressure and an abnormal structure of the ruptured vessel.…”

“…Some authors have stated that the peculiarity of PSHP is a sustained hemorrhage resulting from negative intrapleural pressure and an abnormal structure of the ruptured vessel. The incidence of patients with significant hypovolemia (systolic blood pressure, b90 mm Hg) varies between 30% and 46% [4,7].…”

“…Primary spontaneous hemopneumothorax is more likely to affect young and thin males, and most reports are of Asian origin [4,7]. Unlike other spontaneous hemothorax events caused by malignancy, congenital cystic adenomatoid malformation, or coagulopathy, the mechanisms of bleeding in PSHP are well described [6].…”

“…Primary spontaneous hemopneumothorax (PSHP) is also an uncommon, life-threatening, emergency condition if bleeding persists or recurs. The reported incidence of PSHP is 1% to 12% of all cases of PSP [4].…”