Idiopathic Massive Spontaneous Hemothorax: Adhesion Disruption

Abstract

Disruption of pleural adhesions may cause massive hemothorax, requiring early surgical intervention. After thoracotomy the outcome in these patients is excellent.

Serious complications in COVID-19 ARDS cases: pneumothorax, pneumomediastinum, subcutaneous emphysema and haemothorax

“…However, no clinical finding (like haematuria, haematochezia, melena and haemorrhagic tracheal secretions) of haemorrhage that may form due to high anticoagulant treatment was observed. When this situation is assessed in light of the literature, this patient monitored with invasive MV for a long duration (>12 days) was considered to have separation of adhesions between the pleura leaves forming due to the large amount of variation in pleural pressure with the advance of subpleural localised infection and that haemothorax may be due to this [31, 32].…”

X-Ray Quiz: A 27-Year-Old Male with Sudden Dyspnoea

“…Many causes are implicated in the etiology of spontaneous haemothorax, including neoplasm, coagulation disorders, arteriovenous malformation, ruptured aneurysms, endometriosis, and pulmonary vascular malformations. 1 Simultaneous appearance of both pneumothorax and haemothorax is widely reported. However, when more than 400 ml of blood have accumulated in the pleural cavity without trauma or obvious causes, it is defined as spontaneous haemopneumothorax (SHP).…”

“…4 The mechanism of SHP is suspected to be a torn pleural adhesion band between the parietal and visceral pleura resulting from the collapsed lung and mostly caused by pneumothorax, aberrant vessels, or rupture of the vascularised bullae. 1,4 The adhesions are commonly located between the lung apex and Sibson's fascia and may involve the aorta, subclavian vessels, and pericardium (reason unknown). 1,4 Rare cases like our patient, who presented with haemopneumothorax following an initially simple pneumothorax, are suspected to be due to a worsened collapsed lung after exposure to external pressure because of the catheter inserted into the pleural cavity.…”

“…1,4 The adhesions are commonly located between the lung apex and Sibson's fascia and may involve the aorta, subclavian vessels, and pericardium (reason unknown). 1,4 Rare cases like our patient, who presented with haemopneumothorax following an initially simple pneumothorax, are suspected to be due to a worsened collapsed lung after exposure to external pressure because of the catheter inserted into the pleural cavity. Subsequently, the vessels of the pleural adhesion band were torn.…”

Spontaneous Hemothorax: What is in a Name?

“…We read with interest the article by Singh et al [1] on their experience of managing patients with idiopathic massive spontaneous hemothorax. As the authors clearly stated, it is rare to find rupture of pleural adhesions spontaneously causing massive hemothorax alone (apparently without pneumothorax).…”