Spontaneous hemopneumothorax revisited: Clinical approach and systemic review of the literature

Background. Spontaneous hemopneumothorax, defined as the accumulation of more than 400 mL of blood in the pleural cavity in association with spontaneous pneumothorax, is a rare entity occurring in young patients and may be life threatening. Although many reports of case studies and series have been published in the world literature, the lack of consistent intraoperative findings and varying surgical methods require a review study. Methods. We discuss the clinical features, management, surgical findings, and outcomes of our own patients with spontaneous hemopneumothorax. Results. From September 1997 to September 2003, 488 patients with spontaneous pneumothorax were treated at our hospital. Of these patients, 27 (5.5%) had spontaneous hemopneumothorax develop. These 27 patients were comprised of 25 men and 2 women ranging in age from 15 to 39 years (mean age, 22.3 years). The amount of blood that was drained ranged from 400 to 1,700 mL (mean, 1,012 mL). Twenty-one patients underwent video-assisted thoracoscopic surgery within 1 day after admission; the remaining 6 patients were treated conservatively with tube thoracostomy alone. On arrival at our emergency room, 9 patients (33.3%) experienced hemodynamic instability with hypovolemic shock. In a review of 6,396 patients with spontaneous pneumothorax in the literature and in our current study, 201 patients (3.1%) had spontaneous hemopneumothorax develop. One hundred seventy-six patients (87.6%) were treated surgically, whereas video-assisted thoracoscopic surgery has been performed in 48.9% of patients (86 of 176). There was no recurrence of hemopneumothorax in any of the 201 patients with spontaneous hemopneumothorax after treatment during the follow-up period. Conclusions. Thus one-third of the patients with spontaneous hemopneumothorax had shock symptoms develop. Video-assisted thoracoscopic surgery may be considered as an initial treatment procedure for patients with spontaneous hemopneumothorax, whereas conservative treatment is effective and may be performed in selected patients.