Spontaneous Massive Hemothorax Research Articles

Massive spontaneous hemothorax caused by benign solitary schwannoma

Massive spontaneous hemothorax caused by benign solitary schwannoma

A case of spontaneous hemothorax causing massive pleural effusion following laparoscopic sleeve gastrectomy

Background: Pleural effusion is a rare complication of sleeve gastrectomy. It has many possible etiologies, including gastric leakage, gastropleural fistula formation, splenic abscess, and complications related to administered medications, such as spontaneous hemothorax secondary to anticoagulants. Case Presentation: An unusual case of a 46-year-old woman was reported, who was presented to the emergency room (ER) 10 days after laparoscopic sleeve gastrectomy complaining of dyspnea, chest pain, and dry cough for 4 days. Imaging confirmed massive pleural effusion on the left side. The patient showed improvement after intensive care unit (ICU) admission and drainage via the chest tube. Conclusion: Sleeve gastrectomies are associated with several complications. Low-molecular-weight heparin (LMWH) as prophylaxis for portal vein thrombosis leads to a spontaneous hemothorax. Unfortunately, computed tomography with contrast could not be performed because of vital instability. However, it was concluded that a massive spontaneous hemothorax occurred due to LMWH. The patient was admitted to ICU and underwent slow drainage of pleural effusion until complete recovery

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.

Pregnancy complicated by neurofibromatosis type 1 in a patient with a history of massive spontaneous hemothorax: a case report

Pregnancy complicated by neurofibromatosis type 1 in a patient with a history of massive spontaneous hemothorax: a case report

Spontaneous hemothorax: A rare lethal pulmonary complication of neurofibromatosis type 1

Neurofibromatosis 1 (NF1), also called von Recklinghausen’s disease, is an autosomal dominant disease characterized by multiple non-cancerous tumors of nerves and skin, and areas of abnormal pigmentation. Vasculopathy and spontaneous hemothorax are rare complications, but potentially lethal, which necessitates quick and decisive intervention to save the life of the patient. Here, we present a case of spontaneous massive haemothorax leading to hemorrhagic shock in a 66-year-old woman with neurofibromatosis type-1. She was investigated and managed successfully.

Spontaneous massive hemothorax as a complication of necrotizing pneumonia in a patient with severe acute respiratory syndrome coronavirus 2 induced acute respiratory distress syndrome: a case report

BackgroundWe present an unusual bleeding complication in a patient with severe acute respiratory distress syndrome in coronavirus disease 2019.Case presentationThe patient, a 63-year-old Caucasian man, received venovenous extracorporeal membrane oxygenation support after rapid deterioration of lung function on day 6 after admission to hospital. After initial stabilization on lung protective ventilation and prone positioning, he started to develop mild bleeding complications until he went into occult profound hemorrhagic shock. Causative was a massive hemothorax of the right hemithorax with mediastinal shifting due to spontaneous bleeding from a pulmonal artery in a heavily remodeled right inferior lobe. Histopathological examination of the resected tissue showed signs of an organizing fibrinous pneumonia with focal parenchyma necrosis. After surviving a massive bleeding event caused by necrotizing pneumonia, the patient made a swift recovery and was discharged to rehabilitation 31 days after initial hospital admission.ConclusionsThe combination of severely elevated inflammatory markers and pulmonary hemorrhage should arouse suspicion of necrotizing pneumonia. In necrotizing pneumonia, the possibility of severe intrathoracic bleeding complications should be kept in mind if it comes to sudden deterioration of the patient.

Dabigatran Use Associated with Hemopericardium and Hemothorax

Concurrent spontaneous hemopericardium and hemothorax due to anticoagulant use are extremely rare in clinical practice. Dabigatran is an oral direct thrombin inhibitor approved to prevent stroke or thromboembolic episodes in patients with nonvalvular atrial fibrillation. We report the case of a 73-year-old man who received dabigatran therapy (150 mg twice a day) for 3 months and developed massive spontaneous hemothorax and hemopericardium associated with fever. Emergency chest computed tomography scan established higher-density pericardial effusion (22HU) and left pleural effusion of heterogeneous density (5–15 HU) which could be hemorrhagic content while the heart ultrasound finding confirmed pericardial effusion 7–9 mm thick, without affecting hemodynamics. Almost 1100 mL of blood was drained by ultrasoundguided thoracentesis. After excluding other possible causes, diagnostic withdrawal was performed for dabigatran and no further pleural or pericardium effusion developed after dabigatran was discontinued. Therefore, practitioners could be aware of hemothorax as well as hemopericardium as a potential complication of dabigatran therapy.

Massive Spontaneous Haemothorax after Rivaroxaban Therapy for Acute Pulmonary Embolism.

Spontaneous haemothorax complicating the treatment of pulmonary embolism is rare and potentially fatal. We describe a patient with pulmonary embolism and severe pleuritic pain who developed a life-threatening haemothorax 10 days later while on rivaroxaban therapy. This case highlights the fact that severe pleuritic pain associated with pulmonary embolism may indicate subclinical infarction of tissue near the visceral pleura with an increased risk of pleural effusion and the subsequent development of a haemothorax. It is important to recognise such danger signs warranting closer attention, especially since the increased use of direct oral anticoagulants has facilitated ambulatory care and this complication may manifest in the outpatient setting.LEARNING POINTSSpontaneous haemothorax may occur in the first 2 weeks after a patient starts anticoagulation.Severe pleuritic pain in a patient with pulmonary embolism may indicate subclinical infarction near the visceral pleura with an increased risk of pleural effusion and the subsequent development of a spontaneous haemothorax.Patients with severe pain and pleural effusion should be monitored closely, especially if they are outpatients, even though initial radiological findings are not significant.

Spontaneous massive hemothorax related to a neurofibroma: A case report

Spontaneous massive hemothorax related to a neurofibroma: A case report

SPONTANEOUS HEMOTHORAX SECONDARY TO APIXABAN

SESSION TITLE: Disorders of the Pleura SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: Hemothorax is usually related to chest trauma or iatrogenic from procedures such as central lines, thoracentesis [1]. Spontaneous hemothorax is defined as pleural fluid hematocrit greater than 50% of the peripheral blood hematocrit and the absence of natural or iatrogenic trauma affecting the lung or pleural space.Coagulopathy secondary to anticoagulant use has been associated with spontaneous hemothorax [2,3]. We present a case of spontaneous massive hemothorax in a patient taking apixaban for venous thromboembolism disease. To our knowledge, this is the first case report of apixaban as a cause of spontaneous hemothorax. CASE PRESENTATION: A 56-year-old woman with end-stage renal disease (ESRD) on hemodialysis (HD), diagnosed with upper extremity deep vein thrombosis (DVT) one month prior to presentation and started on apixaban presented with dyspnea and left-sided pleuritic chest pain for two weeks. She was found to have left sided large pleural effusion which was diagnosed as hemothorax after thoracentesis. Other etiologies for spontaneous hemothorax were excluded and drainage by 12-french pigtail catheter achieved total resolution of hemothorax in three days. DISCUSSION: Apixaban is a DOAC used to prevent stroke or thromboembolic events in patients with nonvalvular atrial fibrillation and to prevent recurrent venous thromboembolic disease [7, 8]. Events such as gastrointestinal, intracranial and soft tissue bleedings have been well-documented. However, bleeding manifestation as hemothorax is seldom reported [7]. Our patient presented with isolated left-sided large pleural effusion which was hypoechoic when examined by ultrasound and might be attributed to her being anticoagulated with apixaban. 12-Fr pigtail catheter drainage was effective in the management of our patient and provided total resolution in three days. CONCLUSIONS: Spontaneous hemothorax is a rare complication of anticoagulant therapy and might not exhibit the usual radiological signs of traumatic hemothorax. Health care providers should have high index of suspicion for spontaneous hemothorax when evaluating new pleural effusion in patients receiving DOACs therapy. Drainage by small bore pigtail catheter might be as effective as larger chest tubes without precipitating patient discomfort. Reference #1: 1. Ali HA, Lippmann M, Mundathaje U, Khaleeq G. Spontaneous hemothorax: a comprehensive review. Chest 2008;134:1056–1065 Reference #2: 2. Morecroft JA, Lea RE. Haemothorax: a complication of anticoagulation for suspected pulmonary embolism. Br J Clin Praet 1988; 42:217-218 Reference #3: 3. Diamond MT, Fell SC. Anticoagulant-induced massive hemothorax. NY State J Med 1973; 73:691-692 DISCLOSURES: No relevant relationships by Mohammad Abu Hishmeh, source=Web Response No relevant relationships by Priyasha Srivastava, source=Web Response

Correction to: Dabigatran-Induced Massive Spontaneous Hemothorax.

Page 3, Table2, 'Renal function indexes at different dates after admission': The cell entry in column 2, detailing the patient's urea concentration (μmol/L) on Day 1.

Dabigatran-Induced Massive Spontaneous Hemothorax.

Spontaneous hemothorax due to anticoagulant use is extremely rare in clinical practice. Dabigatran is a novel anticoagulant to prevent stroke or thromboembolic episodes in patients with nonvalvular atrial fibrillation. We report on an 83-year-old man who received dabigatran therapy (110 mg twice daily) for 7 months and developed massive spontaneous hemothorax and acute renal failure. The patient was admitted to the hospital with complaint of a dull ache in the chest and dyspnea. Chest computed tomography scan revealed massive pleural effusion in the left hemithorax with atelectasis. Acute renal failure was observed 4 days later after admission. Almost 2500 mL of blood was repeatedly drained by ultrasound-guided thoracocentesis, followed by a dramatic decrease in serum red blood cell count, hemoglobin and hematocrit. After excluding other possible causes, diagnostic withdrawal was performed for dabigatran, and plasma transfusion was conducted to supply the lost blood volume. A causal relationship was established, because the patient’s renal function gradually improved and no further pleural effusion developed after dabigatran was discontinued. This is a rare case report of massive spontaneous hemothorax caused by dabigatran. Therefore, practitioners should be aware of hemothorax as a potential complication of dabigatran therapy.

Spontaneous haemothorax caused by a ruptured oesophageal artery

Spontaneous haemothorax is a subcategory of haemothorax that occurs in the absence of trauma or other causes. It is a rare emergency that can progress rapidly with massive blood loss leading to haemorrhagic shock and death. We describe a patient with massive spontaneous haemothorax caused by the disruption of an oesophageal artery from the middle segment of descending thoracic aorta. We sutured the bleeding artery in an emergency thoracotomy after the failure of interventional procedure.

Solitary fibrous tumour of the pleura presenting as a spontaneous massive haemothorax.

Solitary fibrous tumours of the pleura are rare neoplasms. These tumours are generally asymptomatic and incidentally diagnosed. Symptoms, if present, are nonspecific such as cough, dyspnea, and chest pain. This report describes the case of a 38-year-old woman admitted to our department after the onset of a right massive spontaneous haemothorax requiring emergency surgical treatment. Intraoperatively a bleeding pleural mass was found to be the cause of the haemothorax. The tumour was successfully resected and the patient made an uneventful recovery. Histological examination revealed the mass to be a solitary fibrous tumour of the pleura.

Spontaneous hemothorax following thrombolytic and anticoagulant therapy for massive pulmonary embolism

Massive spontaneous hemothorax following combined thrombolytic and anticoagulant therapy for pulmonary embolism(PE) is a rare event that is little documented in the literature. Here, we describe a rare case of spontaneous hemothorax in a 23-year-old woman with underlying systemic lupus erythematosus following combined administration of tissue plasminogen activator and low-molecular-weight heparin for massive PE. This report of our successful treatment of this case by video-assisted thoracoscopic thoracotomy demonstrates that although the occurrence is rare, massive hemothorax following anticoagulant and/or thrombolytic therapy for PE should be suspected if patients experience chest pain, dyspnea, or signs of anemia, and follow-up physical examination and hemogram should be performed to facilitate diagnosis of this life-threatening complication.

Dyspnea, Massive Effusion and Lytic Rib Lesion as Initial Presentation of Multiple Myeloma in a Young Man

Multiple myeloma, a disorder commonly encountered in elderly patients, represents a malignant proliferation of plasma cells that primarily affects bone marrow. Pleural effusion as the presenting manifestation of the disease is uncommon. The authors report a case of multiple myeloma with unusual features presenting at a relatively young age with massive spontaneous hemothorax and multiple thoracic masses completely obscuring rib shadow on plain chest imaging. The patient demonstrated a good response to melphalan chemotherapy without recurrence of effusion or the need for additional chemical or surgical pleural interventions.

Spontaneous Massive Hemothorax in a Patient with Neurofibromatosis Type 1 with Successful Transarterial Embolization

Vascular involvement in neurofibromatosis type 1 is rare but has the potential to be fatal. We report a case of a patient with spontaneous rupture of a left intercostal artery aneurysm, which presented as a massive left hemothorax and was successfully treated by transarterial coil embolization.

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.

Pulmonary arteriovenous malformation with spontaneous haemothorax

Pulmonary arteriovenous malformation (PAVM) is a very rare congenital vascular abnormality of the lung. PAVM are usually asymptomatic in presentation. The occurrence of Pulmonary haemorrhage in patients with Pulmonary arterio -venous malformation is very rare. Pulmonary haemorrhage is a very lethal complication of Pulmonary arteriovenous malformation and it should be treated aggressively. Depending upon the location, either massive haemoptysis or haemothorax will occur. We report a case of 36 year old female who was evaluated for spontaneous massive haemothorax on the right side and detected to have large PAVM. She was successfully treated with right lower lobectomy.

Massive Hemothorax Secondary to Metastatic Renal Carcinoma

We present the case of a 78-year-old man with a past history of nephrectomy for renal cell carcinoma who was brought to the emergency room in hypovolemic shock after suddenly collapsing at home. A chest roentgenogram taken on admission showed a large pleural effusion on the right with a mediastinal shift to the left. A contrast computed tomographic scan of his chest excluded aortic dissection. An emergency right thoracotomy was performed, which revealed a chest wall tumor that was bleeding profusely. The tumor was biopsied after the bleeding was controlled. The histologic report revealed metastatic renal cell carcinoma, which is a rare cause for a spontaneous massive hemothorax.