Cause Of Hemothorax Research Articles

Modern treatment of massive hemothorax

Introduction and objective: Hemothorax is an umbrella term for pathologies with an extremely wide range of etiology and severity. Most commonly it is of tramuatic origin, frequently iatrogenic (intervention, blood coagulation altering therapy) and rarely unknown. Depending on the cause, volume, and dynamics, it requires a patient-adapted treatment determined by access to certain therapeutical methods. We aim to provide a practical overview of these. Methods: Retrospective analysis of patients treated for haemothorax at the Thoracic Surgery Department of Borsod-Abaúj-Zemplén County Teaching Hospital in the period 1 January 2017–31 December 2021 has been performed. We used the hospital’s database to collect data. In this paper, we analyze the cause of hemothorax, method of treatment, the efficacy of chosen therapeutic modality, duration of hospital stay, complication rate, 30-day survival. Results: 77 patients were treated with hemothorax, 57 male, 20 female patients. Average age was 53,4 (23–90, SD:14,9) years. Surgery was performed in 31 cases, with 10 cases needing reintervention. In 7 cases, multimodal approach was chosen, with chest wall stabilization. Average hospital stay: 14 (2–79) days. 30-day survival: 95%. Discussion: Thoracic drainage is our first therapeutic choice. The methods used in the treatment of hemothorax in our practice have been extended with the use of digital subtraction angiography (DSA), which yields immediate and effective bleeding control. We performed video-assisted thoracoscopic surgery (VATS) in increasing numbers. Conclusions: As long as the intensity of bleeding and patient’s general status allows it, after drainage, the first therapeutic option – when accessible – should be DSA bleeding control. In cases which do not resolve after drainage, VATS evacuation of hematoma is a safe method used in the treatment of hemothorax. In the past 5 years, we used thoracoscopy in increasing numbers while treating this entity. Based on our results and the literature, we can safely state that the use of thoracoscopy in the treatment of hemothorax is a safe and reliable option in eligible patients, and the results are comparable with those treated by thoracotomy.

Focal dissection and rupture of left atherosclerotic subclavian artery: a rare cause of haemothorax

We report a rare case of a focally dissected and ruptured atherosclerotic left subclavian artery leading to haemothorax. A man in his 50 s who suffered from hypertension and gout was found dead in bed unexpectedly. Postmortem examination showed a focally dissected and ruptured atherosclerotic left subclavian artery with relatively disease-free aorta and major branches. Although theoretically possible, focal atherosclerosis of left subclavian artery compounded by hypertension causing focal dissection and rupture is not previously reported in literature.

Morbidity and mortality of iatrogenic hemothorax occurring in a cohort of liver transplantation recipients: a multicenter observational study.

Hemothorax (HT) is a life-threatening condition, mainly iatrogenic and poorly explored in Liver Transplantation (LT) recipients. The aim of this study is to report and analyze for the first time incidence and outcomes of HT in LT recipients, as well as to suggest a management strategy. Data concerning 7130 consecutive adult liver and liver–kidney transplant recipients were retrospectively collected from ten Transplantation Centers’ institutional databases, over a 10-year period. Clinical parameters, management strategies and survival data about post-operative HT were analyzed and reported. Thirty patients developed HT during hospitalization (0.42%). Thoracentesis was found to be the most common cause of HT (16 patients). A non-surgical management was performed in 17 patients, while 13 patients underwent surgery. 19 patients developed thoracic complications after HT treatment, with an overall mortality rate of 50%. The median length of stay in Intensive Care Units was 22 days (IQR25–75 5–66.5). Postoperative hemothorax is mainly due to iatrogenic causes in LT recipients. Despite rare, it represents a serious complication with a high mortality rate and a challenging medical and surgical management. Its occurrence should always be prevented.

RIB OSTEOCHONDROMA PRESENTING AS HEMOTHORAX

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Osteochondroma’s are benign tumors most commonly found on the long bones of the leg, pelvis or shoulder blade. Usually benign, much of the management is set around observation and symptom control. The next step would be surgical excision of the tumor along with pathological analysis and close monitoring for malignant transformation or recurrence. This case further supports possible complications of osteochondromas. CASE PRESENTATION: A 21 yo M with no significant past medical history presented with right sided posterior back pain along the 6th-9th rib. Pain was sharp, worsened with inspiration and movement and radiated to the right shoulder. An XR Chest showed moderate right pleural effusion along with a mass projecting over the right anterior 6th and 7th intercostal space. A CT Chest showed and exophytic sclerotic/well corticated bony lesion arising from the inferomedial aspect of the anterior right sixth rib measuring 3.1 x 3.8 x 3.3 cm. It was invading he intercostal space between the sixth and seventh rib along with the diaphragm at the anterolateral sulcus. Additionally, a right-sided pleural effusion was better visualized showing material in the inferior aspect consistent with blood products. An US-Guided thoracentesis drained 1L of cloudy/bloody fluid. No malignant cells identified and no growth on culture. CT Surgery was consulted and patient underwent excision of the chest wall tumor including partial resection of the 6th rib. The 7th rib did not show any involvement. The chest cavity was also entered where a large loculated hemothorax was seen. This was evacuated along with decorticating of the right lower lobe due to thickened pleura and old blood products. The exophytic mass and rib were sent to pathology for gross and histologic examination. The histologic features showed a cartilaginous cap, trabecular bone, normal hematopoiesis characteristic for osteochondroma. DISCUSSION: Upon literature review it seems there are several case reports reported in the literature showing complications caused by osteochondromas of the thoracic cage. Much of the literature review showed hemothorax as the most common complication as well as diaphragmatic and intrapericardial penetration. This case report seeks to further report another case of a osteochondroma arising from the rib presenting as a hemothorax along with diaphragmatic involvement. Additionally, similar case reports reviewed in literature shows his presentation may be a common complication of osteochondromas arising from the rib. CONCLUSIONS: Osteochondromas, although mostly benign may present with complications should they arise from sites other than the long bones of the body where they are most commonly found. One of the most common complications seen in literature is hemothorax if arising from the thoracic cavity. Clinicians should be aware of this presentation of a pleural effusion and mass arising from the rib. Reference #1: Kitsoulis P, Galani V, Stefanaki K, et al. Osteochondromas: review of the clinical, radiological and pathological features. In Vivo. 2008 Sep-Oct;22(5):633-46PDF) Reference #2: Keith G. Buchan, Vipin Zamvar, Kayapanda M. Mandana, E. Nihal, P. Kulatilake, Juxtacardiac costal osteochondroma presenting as recurrent haemothorax, European Journal of Cardio-Thoracic Surgery, Volume 20, Issue 1, July 2001, Pages 208–210, https://doi.org/10.1016/S1010-7940(01)00721-7 Reference #3: Harrison, N. K., Wilkinson, J., O'Donohue, J., Hansell, D., Sheppard, M. N., Goldstraw, P. G., Davison, A. G., & Newman Taylor, A. J. (1994). Osteochondroma of the rib: an unusual cause of haemothorax. Thorax, 49(6), 618–619. https://doi.org/10.1136/thx.49.6.618 DISCLOSURES: No relevant relationships by Rajeev Sharma, source=Web Response

Hémothorax spontané révélant une endométriose pleurale

Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis. We report the case of a 36year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed. Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age.

Primary Spontaneous Hemothorax secondary to Lung Adenocarcinoma

Spontaneous haemothorax is a clinical entity encompassing non traumatic accumulation of blood within the pleural space. Although hemothorax is often encountered in clinical practice, spontaneous hemothorax is an infrequent occurrence. Cases of spontaneous hemothorax have known to occur secondary to coagulopathy, malignancy, av malformations, pulmonary infarction and tuberculosis. The neoplasms known to be associated with hemothorax include schwannomas, Hepatocellular carcinoma and soft tissue tumors. lung carcinoma is a rare cause of hemothorax even in the setting of pleural extension. Here we highlight the importance of diagnosis spontaneous hemothorax in case of a primary lung malignancy. A 75 year old woman with no significant past medical history, who presented to the ED with chest pain, was initially diagnosed with a pulmonary embolism. As a part of the work up for cause of pulmonary emboli in this otherwise healthy woman, a CT chest performed revealed an incidentally found right hilar lung mass and she was scheduled for an outpatient workup. A month later, she developed shortness of breath and presented to the ED before her scheduled appointment. A large pleural effusion was seen on the repeat CT chest. She underwent thoracocentesis, with pleural studies consistent with hemothorax. Eventually, she underwent endobronchial ultrasound with biopsy of lung mass. Based on the histopathology findings, she was diagnosed with adenocarcinoma. We concluded that she likely experienced spontaneous hemothorax secondary to lung adenocarcinoma. To our knowledge there have been three other case reports of spontaneous hemothorax secondary to bronchogenic carcinoma. Cases of hepatocellular carcinoma with hemothorax have been known to have poor prognosis. Being uncommon, the prognostic implication of spontaneous hemothorax in primary lung malignancies has not been studied. Recognition of hemothorax in these patients can alter the course of management.

Intercostal artery pseudoaneurysm following thoracentesis: multi-modal imaging and treatment

BackgroundA pseudoaneurysm occurs as the result of a contained rupture of an arterial wall, yielding a perfused sac that communicates with the arterial lumen. Pseudoaneurysm of an intercostal artery is an extremely rare event but it carries with it a significant risk of rupture and subsequent hemothorax. It must be considered as a potential complication of thoracentesis.Case presentationHere, we report a rare case of an intercostal artery pseudoaneurysm following thoracentesis in an 82-year old male. The patient presented with respiratory distress 1 day after a therapeutic thoracentesis had been performed. Computed tomography (CT) with contrast revealed a left intercostal pseudoaneurysm with hemothorax and adjacent compressive atelectasis. Doppler ultrasound revealed bidirectional blood flow in the pseudoaneurysm sac. An intercostal arteriogram and thoracic aortogram aided in confirmation of the pseudoaneurysm and successful treatment with coil embolization.ConclusionsAn intercostal pseudoaneurysm complication following thoracentesis is very rare but important to rule out as a possible cause of hemothorax after the procedure. Capturing this finding with the aid of multiple imaging modalities allowed for diagnostic certainty and rapid treatment with coil embolization, leading to a successful patient recovery.

Vitamin K deficiency-induced hemorrhagic shock after thoracentesis: a case report

BackgroundVitamin K deficiency results in serious coagulation dysfunction, but hemorrhagic shock is rare. Herein, we describe a case of vitamin K deficiency and abnormality in the path of the intercostal artery, the combination of which led to hemorrhagic shock.Case presentationAn 83-year-old woman was hospitalized for suspected gallstones. She developed septic shock after 4 days of hospitalization. We considered cholecystitis or cholangitis and performed abdominal ultrasonography, which revealed gallbladder enlargement, biliary sludge, and hyperplasia of the bile duct wall. Antibiotic treatment with sulbactam/ampicillin (SBT/ABPC) was initiated on day four, and percutaneous transhepatic gallbladder drainage (PTGBD) was performed on day five. The treatment was successful, but the patient developed bilateral pleural effusion because of hypoalbuminemia. We performed drainage for bilateral pleural effusion on days 13 and 17. The patient developed hypotension on day 18; blood tests showed anemia and severe coagulation dysfunction but a normal platelet count. We suspected vitamin K deficiency-induced coagulation dysfunction because of previous antibiotic treatment and restricted diet, and it led to hemorrhagic shock. Massive right hemothorax was observed by computed tomography, and urgent interventional radiology was performed. We observed no injury to the intercostal artery truncus but confirmed an abnormality in the course of the intercostal artery; therefore, we inferred that the cause of hemothorax in this case was injury to a small vessel, not truncus because of the abnormality. Because of the likelihood of rebleeding, we performed coil embolization from the seventh to the ninth intercostal artery. Because we confirmed vitamin K deficiency-induced coagulation dysfunction, we referred to the concentration of protein induced by vitamin K absence/antagonist-II (PIVKA-II), and it was found to increase by 23,000.ConclusionsA combination of vitamin K deficiency and abnormality in the course of the intercostal artery led to hemorrhagic shock. When using certain antibiotics and restricting diet, it is important to measure coagulation function, even if the platelet count is normal. Further, when thoracentesis is performed, abnormalities in the course of the intercostal artery should be identified. Thoracentesis with ultrasound may prevent hemothorax.

Multiple-site bleeding at pleural adhesions and massive hemothorax following percutaneous coronary intervention with stent implantation: A case report.

An elderly male patient with coronary heart disease underwent coronary angiography, which revealed bilateral severe coronary artery stenosis. Four stents were implanted, and at 5 h post-surgery, typical hemorrhagic shock appeared. Echocardiography verified heavy bleeding in the right thoracic cavity. Emergency angiography excluded injury or perforation of the coronary artery, aorta, right subclavian artery and brachiocephalic artery. Considering the patient's history of chronic obstructive pulmonary disease and severe cough during the operation, it was suspected that hemothorax was induced by a blood vessel rupture in the pleura. Video-assisted thoracic examination confirmed the tearing of pleural adhesion bands and bleeding at three sites in the pulmonary pleura and parietal pleura. According to the reported case, bleeding as a result of the laceration of pleural adhesions is an important cause of hemothorax that should be considered after exclusion of other common causes of pleural hemorrhage.

The interstitial disease of the lungs revealed by a histological study

The authors report a case of the interstitial disease of the lungs revealed by a histological study that demonstrated intravital diagnostic faults in the patient in question. Moreover, a postmortem diagnostic error occurred; namely, the macroscopic study of the thoracic organs had shown the 0.5 cm long linear rupture of the adhesion in the right lung root region that was considered to be the cause of hemothorax and anemia of the internal organs which supposedly resulted in the patient's death. The definitive diagnosis of interstitial disease of the lungs was established based on the results of the histological study. The histological picture of the process is illustrated.

Delayed Hemothorax Caused by Thymic Bleeding After Blunt Chest Trauma

Hemothorax is a blood accumulation in the pleural cavity. Symptoms can include anxiety; chest pain; low blood pressure; pale, cool, and clammy skin; rapid heart rate; rapid shallow breathing; restlessness; and shortness of breath. The most common cause of hemothorax is chest trauma. Here we present a case of delayed massive right hemothorax caused by thymic bleeding after blunt chest trauma.

Bilateral Spontaneous Hemothorax with PNET: a case report and review

Background: Neuroectodermal Tumors (PNET) are malignant small cells neoplasm mainly occurring in children but can occur at any age. Extensive bleeding into the pleural cavity is rare In Children. Hemothorax would be compatible with a variety of congenital anomalies including sequestration, patent ductus artreiosus, and pulmonary arteriovenous malformation. Case report: A 2.5-years old girl who was known a case of PNET with dyspnea and tachypnea referred to our hospital. The chest X-ray revealed bilateral opacity. After consulting the general surgeon, the bilateral chest-tubes inserted and 200cc blood drained. Discussion: The diagnosis of a hemothorax can be made only by thoracentesis. The symptomatology of the Peripheral Primitive Neuroectodermal Tumors is related to size and their location. We did not find any residue of cancer as a cause of hemothorax, and the hemothorax was not related to side effects of chemotherapy, infection and trauma. Therefore, PNET should be included as a cause of children hemothorax.

A case of hemothorax following seat-belt injury with a bulla in the apex of the lung: a subtype of spontaneous hemopneumothorax

We experienced a case of a subtype of spontaneous hemopneumothorax caused by external forces associated with a seat-belt injury. A female aged 39 years sustained a minor collision with an oncoming car while she was driving. Although pneumothorax was not detected, hemothorax and bleeding from the area surrounding the subclavian artery were observed on contrast-enhanced chest computed tomography (CT). After confirming continuous bleeding into the thoracic cavity after superselective arterial embolization, we performed emergency open surgery. We found a bulla in the apex of the lung, and the thoracic stump of the bulla was considered the source of bleeding. In this case, the direct cause of hemothorax was considered to be the external force associated with the seat-belt injury. When a bulla in the apex of the lung and continuous bleeding are both observed on CT, spontaneous hemopneumothorax should be suspected, necessitating open chest surgery in cases where pneumothorax is not observed.

Traumatic hemothorax: Analysis of 108 cases

To evaluate treatment approaches and follow-up results of patients with hemothorax a total of 108 patients (81 male and 27 female) diagnosed as hemothorax and treated between August 2006 and October 2011 were evaluated retrospectively. The most common cause of hemothorax was blunt trauma (n:92, 85.2%) and 16 cases of hemothorax (14.8%) had a penetrating trauma. Hemothorax after blunt trauma occured due to traffic accidents in 58 cases (63.04%), due to falls from height in 21 cases (22.82%), due to injuries caused by animals in 9 cases (9.78%) and due to roadway crashes in 4 cases (4.34%). Hemothorax after penetrating trauma, on the other hand, occured due to penetrating injuries in 10 cases (62.5%) and due to gunshot injuries in 6 cases (37.5%). In the present study it was found that hemothorax accompanied by other organs injury in 56 cases (51.8%) and extremity fractures also present in 24 cases (22.2%). Thoracotomy was performed in 14 cases and median sternotomy in one case. Mortality was detected in 5 cases (4.6%). Hemothorax after thoracic trauma is an emergency which needs to be diagnosed immediately, inquired about accompanying organ injuries and treated accordingly. J. Exp. Clin. Med., 2013; 30:31-33

Pleural endometriosis: an exceptional cause of hemorrhagic pleural effusion.

The differential diagnosis of bloody pleural effusions is relatively narrow. Trauma, iatrogenic or otherwise, represents the most common cause of hemothorax. Other common causes of bloody pleural effusion include malignancy (primary or metastatic), tuberculosis, pulmonary embolism, and serositis from collagen vascular diseases such as rheumatoid arthritis and systemic lupus erythematosus. Clinical history along with pathologic, microbiologic, and biochemical evaluation pleural fluid evaluations confirm the diagnosis in most cases. However, if repeated pleural fluid examination reveals only hemorrhagic effusion without corroborative history or mass lesion in lung, or evidence of microorganisms, then a search for uncommon etiology is necessary. Endometriosis most commonly occurs in the ovaries, uterine ligaments, rectovaginal septum, Cul-de-sac, and the surrounding peritoneum of pelvic organs [1]. Thoracic endometriosis syndrome (TES) is an exceptional condition. There were reported only 38 pathologically documented cases of TES (pleural–21 cases, and parenchymal–17 cases) in the literature till the year 2000 [1]. One such rare case of pleural endometriosis which created an enormous diagnostic dilemma and ultimately confirmed by histopathologic study is being described.

An unusual cause of spontaneous hemothorax: cardiac angiosarcoma

Angiosarcoma, the most common primary malignant neoplasm of the heart in adults, usually presents as pericardial effusion or right-sided heart failure. Rupture of an angiosarcoma-infiltrated cardiac chamber as a cause of hemothorax is very rare in the literature. In this report, we describe a 34-year-old male patient, who presented to emergency service with sudden chest pain and dyspnea. The diagnostic work-up revealed spontaneous right-sided hemothorax and a large right atrial (RA) mass with suspicious atrial perforation. An urgent surgery showed a vascularized irregular RA mass invading the parietal pericardium and pleura and a perforation of the RA free wall. Histopathologic examination confirmed the diagnosis of angiosarcoma, and the patient was subsequently referred for radiotherapy and chemotherapy.

Left Internal Mammary Artery Injury Requiring Resuscitative Thoracotomy: A Case Presentation and Review of the Literature

Background. Penetrating injuries to the chest and in particular to the heart that results in pericardial tamponade and cardiac arrest requires immediate resuscitative thoracotomy as the only lifesaving technique and should be performed without delay. Objective. To describe an external cardiac tamponade caused by massive tension hemothorax from penetrating injury of the left internal mammary artery (LIMA). Method. A case presentation treated at the Level I trauma center at Hamad General Hospital, in Doha, Qatar and review of the literature on LIMA injuries reported cases. Results. LIMA injury as a cause of hemothorax is not uncommon, but to our knowledge our case is the first massive tension hemothorax with witnessed cardiac arrest reported in the literature requiring emergency thoracotomy, performed in trauma room, with full recovery. Conclusion. Injury to the LIMA with massive tension hemothorax requires immediate resuscitative thoracotomy.

Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report

We present the case of a 30-year-old man with no past history of disease or recent trauma, who was seen in the emergency room after developing sharp pain in the left hemithorax. Chest roentgenogram showed costopherenic angle blunting and an oval mass in the left mediastinum. A computed tomographic scan showed extrapleural mass with coarse calcifications and pleural effusion, confirmed by magnetic resonance imaging. The tumor was biopsied and removed during thoracotomy. The pathology reported revealed chondrosarcoma, which is a rare cause for a spontaneous massive hemothorax. Invasion of the intercostals vessels by the tumor was the probable cause of hemothorax in this patient.

Hemothorax- A rare presentation of congenital strangulated diaphragmatic hernia

We report the case of a 7 years old previously asymptomatic child who initially presented with respiratory distress because of massive left-sided hemothorax but was subsequently diagnosed to be having strangulated small intestine through a diaphragmatic rent on laparotomy. The case is being discussed in detail and the possible causes of hemothorax in such a scenario discussed.

Haemothorax associated with Angiostrongylus vasorum infection in a dog

Angiostrongylosis was diagnosed in a dog presenting with haemothorax on the basis of detection of Angiostrongylus vasorum first-stage larvae both in the pleural effusion and in faeces. A one-year-old, male, mixed-breed dog was presented with fever, depression and persistent cough of one month's duration. Clinical examination revealed temperature of 39.5 degrees C, loud bronchovesicular sounds on thoracic auscultation and attenuated cardiac sounds. Thoracic radiographs showed a moderate bilateral pleural effusion and a diffuse interstitial pulmonary pattern, with an alveolar pattern in one lobe. Routine haematology revealed anaemia and leucocytosis with eosinophilia, basophilia and thrombocytopenia. Coagulation assays showed a consumptive coagulopathy resembling disseminated intravascular coagulation. The relationship between haemothorax and the presence of A vasorum larvae in the pleural effusion is discussed. The dog was successfully treated with fenbendazole until negative for larvae on faecal examination. This case report indicates that A vasorum infection should be considered as a possible aetiological cause of haemothorax in dogs.