Fatal Hemothorax Research Articles

902: A MIX OF FUNGI, AIR, BLEED, AND CLOTS WITHIN A LUNG

Introduction: Spontaneous hemothorax is a rare condition known to be associated with anticoagulation. We describe a case of fatal hemothorax associated with 2 different fungi that presented a therapeutic dilemma. Description: A 74-year-old female with past medical history significant for hyperhomocysteinemia secondary to MTHFR gene mutation, bioprosthetic aortic valve replacement, deep venous thrombosis, pulmonary embolism and paroxysmal atrial fibrillation on therapeutic anticoagulation presented with fever, dyspnea and hemoptysis. CT of the chest showed an actively extravasating left lung hematoma extending into the pleural space with moderate hemothorax and a small focus of gas within the collection and underlying multifocal pneumonia. Systemic anticoagulation was held and she received antibiotics for pneumonia despite which hypoxia worsened and she was intubated. She required pressors secondary to septic shock. She underwent multiple bronchoscopies and chest tube placement despite which she continued to have recurrent hemothorax suspected secondary to an actively hemorrhagic lung abscess. While in the operating room for video-assisted thoracoscopic surgery (VATS) she suffered cardiac arrest with return of spontaneous circulation in 2 minutes that resulted in multiorgan dysfunction. VATS was aborted. Cultures from previous bronchoscopy resulted in growth of Penicillium and Aspergillus species and she was started on antifungal therapy. However, she subsequently developed multiple pulmonary emboli and embolic brain infarcts. In light of clinical deterioration and grim prognosis, the family opted for comfort measures. Discussion: Despite its association with hemoptysis, there are limited studies describing the occurrence of massive spontaneous hemothorax in aspergillosis. Our case is made additionally interesting by the co-infection with Aspergillus and Penicillium species simultaneously. The patient’s hyperhomocysteinemia predisposes her to a prothrombotic state, compounded by atrial fibrillation that was likely the cause of multiple embolic infarcts in paradox to her actively hemorrhagic abscess that precluded systemic anticoagulation. The therapeutic dilemma and rapid clinical deterioration raise the need for further investigation into the condition to augment early diagnosis and intervention.

Fatal hemothorax caused by pleural mesothelioma in a lion

ABSTRACT: Mesothelioma is considered a malignant neoplasm caused by the proliferation of mesothelial cells mostly from the pleura, peritoneum and pericardium. Here we described a case of fatal hemothorax caused by pleural mesothelioma in a lion by means of necropsy, histopathology and immunohistochemistry. Gross inspection of the thoracic cavity showed hemothorax with about 4 liters of blood. Microscopically, numerous, randomly distributed, soft, red-pink, irregular masses with up to 1cm in diameter were observed in both visceral and parietal pleurae. Microscopically, a papillary structure pattern was observed in the thoracic masses, composed mainly by one layer of cubic mesothelial cells, which presented eosinophilic cytoplasm, central nucleus and evident nucleolus, supported by a low cellular fibrovascularstroma. Neoplastic cells were positive for both cytokeratin and vimentin by immunohistochemistry. This seems to be the first report of fatal hemothorax caused by pleural mesothelioma in a lion.

Multiplanar reconstruction technique for difficult computed tomography-guided lung biopsy: Improved accuracy and safety.

We assessed the value of the multiplanar reconstruction technique (MRT) for computed tomography‐guided lung biopsy. We evaluated 72 difficult biopsy cases (traditional method = 44; MRT = 28) to compare patient and lesion characteristics, diagnostic accuracy, complications, radiation dose, and procedure duration. Diagnostic accuracy was significantly higher using MRT than the traditional method (100% vs. 84.1%, respectively; P = 0.038). There were no severe complications in the MRT group, but one case each of severe pneumothorax and fatal hemothorax in the traditional method group. The dose‐length product rate was lower and the procedure duration slightly higher in the MRT than in the traditional group (336.83 vs. 479.64 and 33.39 vs. 25.93 minutes, respectively). MRT using computed tomography‐guided lung biopsy could improve diagnostic accuracy and avoid severe complications compared to the traditional method.

Fatal hemothorax due to homicidal blunt trauma to carotid artery in the neck

A 30-year-old man was found dead in a pool of blood inside his office room in the morning. Autopsy revealed a small contusion at the lower anterior part of neck, laceration on the left common carotid artery, hemothorax and a laceration over the nose with underlying fracture. On investigation, it was found that on the previous night the victim had been assaulted by his domestic help with an iron rod over head and neck. The blunt trauma to the neck resulted in laceration on the left common carotid artery and subsequently bled, causing fatal hemothorax. The authors report this case owing to the rarity of such patterns of injury leading to fatal outcomes, which may be overlooked due to the simple nature of external injuries.

Fatal Hemothorax Caused by Pseudomesotheliomatous Carcinoma of the Lung

We present a case of a poorly differentiated pseudomesotheliomatous carcinoma originating in the lung, which was manifested with the distinctly rare complication of massive true hemothorax and persistent blood loss that proved rapidly fatal in spite of surgery. Pseudomesotheliomatous carcinoma of the lung and neoplasia-associated hemothorax are reviewed and discussed.

Pulmonary arteriovenous malformation causing sudden death due to spontaneous hemothorax

A sudden death due to hemothorax caused by spontaneous rupture of a congenital pulmonary arteriovenous malformation (AVM) is reported. A 44-year-old woman died unexpectedly with chest pain and dyspnea. The post-mortem examination revealed a massive right-sided hemothorax arising from a subpleural AVM of the upper lobe. There were multiple telangiectases in the tongue and the tonsils, as typically associated with Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia, HHT). The post-mortem molecular genetic analysis proved the presence of a disease-causing mutation in the endoglin gene constituting a predisposition for pulmonary AVMs. According to the literature, almost half of the AVMs in the lung are seen in HHT patients. Based on the presented case and the relevant literature, the article addresses the forensic aspects of fatal hemothorax and the importance of detecting the source of bleeding.

Delayed Fatal Hemothorax Due to Traumatic Carotid Dissection: A Case Report of a Previously Unreported Cause of Death

A unique case of delayed fatal hemothorax in a 12-year-old girl resulting from atypical dissection of a traumatic carotid aneurysm is reported, due to occult neck trauma received in a sledding accident which occurred one week prior to death. Aspects of traumatic carotid dissection and forensic implications of delayed presentation of such findings in the setting of occult trauma are discussed.

Fatal Hemothorax from Ruptured Mycotic Celiac Artery Aneurysms

Fatal Hemothorax from Ruptured Mycotic Celiac Artery Aneurysms