Spontaneous hemopneumothorax.

BACKGROUND: Spontaneous hemopneumothorax is a rare disorder, occurring in 1% to 12% of patients with spontaneous pneumothorax. We studied our previously treated patients to determine the nature of optimal operative management.

METHODS: This was a retrospective case study. From 1987 to 1994, of 428 cases of spontaneous pneumothorax that occurred in 234 patients treated at our institution, hemopneumothorax developed in 10 patients (2.3%). The clinical features of these patients were studied.

RESULTS: The amount of bleeding ranged from 600 to 1,600 mL, and 3 patients exhibited symptoms of shock, such as sweating, nausea, and syncope. Six patients underwent operation within 7 days from the onset, and this involved resection of the bullae or pneumorrhaphy, or both. The source of bleeding was identified in 5 patients. Pathologic examination showed marked fibrosis with alcian blue-positive deposits of aberrant vessels. All 6 patients continue to be well postoperatively without recurrence or complications. Four patients did not undergo early thoracotomy. However, decortication was required in 3 of these patients because of a reactive fluid collection in the pleural space, which led to impaired lung expansion.

CONCLUSIONS: Early surgical repair should be considered once diagnosis of a spontaneous hemopneumothorax is confirmed, because this provides better long-term results. Video-assisted thoracoscopic surgery as well as minithoracotomy should be considered as surgical options because of the improved quality of life they confer.