A CASE OF SPONTANEOUS HEMOTHORAX CAUSED BY A PLASMACYTOMA

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: A hemothorax is a bloody pleural effusion with measured hematocrit greater than 50% that patients peripheral blood, which often caused by trauma or iatrogenic injury, in rare occurrences they can develop spontaneously. CASE PRESENTATION: Here we present case spontaneous 63 year-old man past medical history hypertension, tobacco abuse, and smoldering multiple myeloma. This patient initially presented complaints chest pain. His initial vital signs showed temperature 98.5 degrees Fahrenheit, heart rate 81 beats per minute, respiratory 16 breathes blood pressure 112/67 mmHg, an oxygen saturation 100% on room air. laboratory values revealed hemoglobin 7.1 g/dL, his basic metabolic panel was remarkable for sodium level 133 mmol/L, bicarbonate 14 troponin 0.21 ng/mL. All other were within normal limits. electrocardiogram sinus rhythm without concerns ischemia. Acute coronary syndrome ruled out decision made to perform nuclear medicine stress test further risk stratify patient. At this time negative fixed reversible However, it interestingly focal, radionuclide uptake two large masses chest. Given these unusual findings, then underwent computed tomography scan contrast. It destructive boney lesions, largest arising from left seventh rib. Most concerning, there sided accompanying atelactatic lung. DISCUSSION: thoracostomy tube urgently placed, immediate return blood. He would go put 3 liters. oncologist consulted. noted had previous 13 g/dL at most recent oncology appointment months prior admission. also he skeletal survey admission, any lesions. rapid development bone marrow biopsy, confirmed plasma cell malignancy. The drops second day requiring transfusion. repeat angiography performed attempt identify culprit vessel. Unfortunately non-diagnostic, as cases hemothorax, vessel likely tamponade off accumulated managed successfully tube, bleeding. Plans arranged undergo treatment CONCLUSIONS: Spontaneous hemothoraces are rare, when do occur warning sign something more ominous hand. Those affected require multidisciplinary approach. REFERENCE #1: Azfar Ali H, Lippmann M, Mundathaje U, Khaleeq G. hemothorax: comprehensive review. Chest. 2008 Nov;134(5):1056-1065. doi: 10.1378/chest.08-0725. PMID: 18988781. #2: Broderick, S.R. (2013, February). Hemothorax: Etiology, diagnosis, management. Thoracic surgery clinics, 23(1), 89-96,.https://doi.org/10.1016/j.thorsurg.2012.10.003 DISCLOSURES: No relevant relationships Stephanie Scott, source=Web Response