SPONTANEOUS HEMOPNEUMOTHORAX RESULTING IN SHOCK

TOPIC: Cardiothoracic Surgery TYPE: Fellow Case Reports INTRODUCTION: Spontaneous hemopneumothorax (SHP) is a rare disorder reported to occur in approximately 3% of patients with spontaneous pneumothorax (SP) (1). The mechanism involves torn an apical vascular adhesion or aberrant vessels located between the parietal pleura and bulla (2). Large SHP can lead hemodynamic instability shock. Thus, early recognition prompt surgical intervention are key for patient survival. CASE PRESENTATION: A 21-year-old man presented emergency department two-day history pleuritic chest pain dyspnea. There was no trauma past medical noncontributory. Vital signs showed oxygen saturation 94%, blood pressure 110/70, heart rate 106 bpm. Physical examination notable absent breath sounds on left. Chest X-ray left-sided large hydropneumothorax. tube placed, draining 1600ml dark-colored clots. few hours later, went into shock, BP 60/40 HR 130 bpm, hematocrit 29%. central line fluid resuscitation performed, products were given. After stabilization, underwent open thoracotomy removal additional 500ml clotted from his left hemithorax. Bullectomy pleurodesis performed bore placed. discharged two days later complications. DISCUSSION: mostly results SP, young men being disproportionate affected (3). Clinical presentation includes When accompanied by hypotension, hemorrhagic secondary bleeding thoracic cavity, should be suspected. In hemodynamically unstable patients, either video-assisted surgery (VATS) performed. Conservative treatment may considered selected stable CONCLUSIONS: Sudden dyspnea radiologic findings hydropneumothorax diagnostic hypothesis SHP. Early identification prognosis. REFERENCE #1: Hsu NY, Shih CS, CP, Chen PR. revisited: clinical approach systemic review literature. Ann Thorac Surg. 2005 Nov;80(5):1859-63. #2: Kakaris S, Athanassiadi K, Vassilikos Skottis I. hemopneumothorax: but life-threatening entity. Eur J Cardiothorac 2004 May;25(5):856-8. #3: Kim ES, Kang JY, Pyo CH, Jeon EY, Lee WB. 12-year experience hemopneumothorax. Cardiovasc 2008 Jun;14(3):149-53. DISCLOSURES: No relevant relationships Eduardo Ballester, source=Web Response Caroline Blum, Sasckia Duarte, Catherine Wegner Wippel,