Signs and Symptoms of Chest Diseases: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease |

Nontraumatc Spontaneous Right Sided Hemothorax: A Case Report FREE TO VIEW

Muhammad Khan, MBBS; Muhammad Khan, MD; James Walsh, MD
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Guthrie Robert Packer Hospital, Sayre, PA

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

Chest. 2016;150(4_S):1253A. doi:10.1016/j.chest.2016.08.1366
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SESSION TITLE: Student/Resident Case Report Poster - Signs and Symptoms of Chest Disease

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Spontaneous hemothorax is an uncommon condition but is life threatening requiring immediate clinical attention. We present a case of spontaneous right sided hemothorax from intercostal branches of the right main bronchial artery.

CASE PRESENTATION: 70 year old lady was admitted with cough and fever. Her past medical history was significant for recurrent bacterial bronchitis, chronic rhinosinusitis, esophageal dysmotility with microaspiration, seronegative arthritis and asthma. No history of bleeding disorder, antiplatelt, anticoagulation therapyor tobacco use. On admission physical exam was remarkable for temperature 102.6 Fahrenheit and bilateral scattered harsh breath sounds. White cell count was 12.8 thousand , platelet count was 190, INR was 1.08. She was empirically started on IV antibiotics for bronchitis pending culture results. On day 6 of hospitalization, she developed sudden onset right sided excruciating pleuritic chest pain. Physical exam revealed reduced breath sounds right lower chest. Chest x ray showed new onset right lower zone haziness. CT scan showed right hemothorax as evident by extravasation of contrast material into the pleural space (most likely from the intercostal branches of the right main bronchial artery). Her clinical status rapidly deteriorated with acute drop in hemoglobin from 11.3 to 8.2 gram requiring ICU transfer and emergent chest tube palcement for tension hemomthorax. 1.5 liters of frank blood was drained and was transfused packed red cells. She underwent right Video Assisted Thoracoscopy with evacuation of hematoma and partial decortication. Erythema and red sanguineous oozing was noted in the posterior apical hemithorax just superior to the azygos vein which was coagulated using electrocautery.

DISCUSSION: Hemothorax is a life threatening emergency, traumatic etiology should be excluded first. Causes include neoplasia, anticoagulant medications, vascular malformations, pulmonary infarctions, congenital bleeding disorders, extramedullary hematopoiesis, endometriosis and pulmonary tuberculosis. Patient are at high risk of hemodynamic instability and need close monitoring. Coagulation parameters and medications should be reviewed. A contrast enhanced CT of the chest can yield significant information. Video assisted thorcoscopy is the preferred procedure for evacuation of persistent clot. Our patiet did not show active bleeding at the time of thoracoscopy

CONCLUSIONS: Non traumatic hemothorax is an unusual cause of hemothorax with varying causes and may lead to rapidly accumulating new onset hemothorax which can be fatal. Early recognition and treatment are necessary for survival.

Reference #1: Hakim et.al., Spontaneoua hemothorax, a comprehensive review, CHEST 2008; 134:1056 -1065

Reference #2: Felix et.al. A repeat case of spontaneous idiopathic hemothorax, Hospital physician April 1999, 59-62

DISCLOSURE: The following authors have nothing to disclose: Muhammad Khan, Muhammad Khan, James Walsh

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