The Management of Spontaneous Haemopneumothorax

Abstract

Summary Two cases of spontaneous haemopneumothorax are reported and the pathology, clinical features and management of the condition discussed. A plan of management for future cases is proposed.

Video‐assisted thoracic surgery for spontaneous haemopneumothorax

“…Previous reports suggest that SHP can be treated conservatively with chest tube insertion in most patients if the bleeding persisted less than 24 h 22,23 . Surgical intervention is reserved for patients with massive bleeding with haemodynamic instability, persistent bleeding more than 24 h or retained blood clot refractory to tube drainage 14,24–26 . Before 1990, the surgical approach for SHP was usually through thoracotomy, 24–26 which was gradually replaced by VATS approach with or without axillary mini‐thoracotomy 14,15 , 27–29 .…”

“…Surgical intervention is reserved for patients with massive bleeding with haemodynamic instability, persistent bleeding more than 24 h or retained blood clot refractory to tube drainage 14,24–26 . Before 1990, the surgical approach for SHP was usually through thoracotomy, 24–26 which was gradually replaced by VATS approach with or without axillary mini‐thoracotomy 14,15 , 27–29 . At present, VATS has been regarded as an easy, accessible and safe procedure that could be applied as an initial treatment of patients with SHP.…”

Spontaneous haemopneumothorax: a surgical emergency

“…In 1950, MYERS et al [2] performed an emergency thoracotomy to deal directly with the source of haemorrhage. Since that initial description, 17 further cases of emergency thoracotomy for spontaneous haemopneumothorax have been reported in the English world literature [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. The source of bleeding is reported as a torn vascular adhesion in 14 of these 17 cases (82%), though in the remaining three cases no reference is made as to the source of haemorrhage.…”

“…Spontaneous pneumothorax is complicated by intrathoracic haemorrhage causing haemopneumothorax in only 0.5% of cases [1]. Surgical intervention within the first 24 h of presentation is uncommon, with only 13 reports in the English world literature so far [2][3][4][5][6][7][8][9][10][11][12][13][14]. We report a further two cases, and review the sources of intrathoracic haemorrhage in both of these cases and in the others described in the world literature.…”