Critical Care: Inflammatory Diseases Affecting the Lung |

Spontaneous Hemothorax in a Patient With Giant Cell Arteritis FREE TO VIEW

Yasmin Hajja, MD; Ramsy Abdelghani, MD; John Godke, MD
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Baton Rouge General Hospital, Baton Rouge, LA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):302A. doi:10.1016/j.chest.2016.08.315
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SESSION TITLE: Inflammatory Diseases Affecting the Lung

SESSION TYPE: Student/Resident Case Report Slide

PRESENTED ON: Monday, October 24, 2016 at 11:00 AM - 12:00 PM

INTRODUCTION: Giant cell arteritis (GCA) is caused by inflammation of medium and large sized arteries. The aorta and its major branches are predominantly affected, but other arteries may be involved. Major complications can include stroke, myocardial infarction, aortic aneurysm, and visceral organ infarction.

CASE PRESENTATION: An 81-year-old Caucasian male with history of giant cell arteritis, diabetes, hypertension and asbestos exposure presented to his primary care physician for follow up for the workup of anemia after complaining of shortness of breath for the past few months. While in the physician’s office, the patient experienced sudden back pain, loss of consciousness, and seizure-like activity. The episode lasted 1-2 minutes with the patient regaining consciousness. The patient was then immediately sent to our facility. Upon arrival, vital signs were stable, and complete blood count and complete metabolic panel were within normal limits. Physical exam was benign aside from decreased breath sounds in the left lower lung field. Initial chest x-ray showed a large opacity in the left lower lobe. CT angiogram of chest was done in the emergency room, which revealed a mediastinal hematoma, moderate to large left suspected hemothorax with an intact aorta and no evidence of dissection or aneurysmal formation. The patient denied any previous history of malignancy or trauma of any sort. Cardiothoracic surgery was consulted and the patient underwent left video-assisted thoracoscopic surgery (VATS) with drainage of the hemothorax, left parietal pleural biopsy, and subsequent chest tube placement. There were no appreciated signs of bleeding or etiology of his bleed seen on VATS. Approximately 1740 cc of blood was drained with no complications. Biopsy results showed fibro-adipose tissue, with no evidence of malignancy.

DISCUSSION: We present a novel case of spontaneous hemothorax believed to be secondary to giant cell arteritis without preceding aortic aneurysm. Hemothorax of vascular origin is often due to injury to the aorta from dissection or aneurysm, which is usually associated with trauma, hypertension, or congenital aortic anomalies. In this case, the patient presented with spontaneous hemothorax (SH) and did not have any evidence of aortic aneurysm or dissection.

CONCLUSIONS: Regardless of the etiology, SH is a rare clinical entity that can lead to potentially life-threatening complications and warrants immediate treatment and workup. Further investigation to rule out associated underlying disorders is essential. Physicians should be aware of the possibility of developing SH without obvious aortic pathology, as there can be significant associated morbidity and mortality if treatment is delayed.

Reference #1: Spontaneous Hemothorax, Morgan et al Ann Am Thorac Soc. 2015 Oct;12(10):1578-82. doi: 10.1513/AnnalsATS.201505-305CC.

Reference #2: Etiology and management of spontaneous haemothorax, Patrini et al. J Thorac Dis. 2015 Mar;7(3):520-6. doi: 10.3978/j.issn.2072-1439.2014.12.50.

DISCLOSURE: The following authors have nothing to disclose: Yasmin Hajja, Ramsy Abdelghani, John Godke

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