A Young Woman With Spontaneous Hemothorax

Abstract

Spontaneous hemothorax is defined as blood aggregation due to non-traumatic causes. Pulmonary pathologies, pleural pathologies, lung tumors, stomach pathologies, blood dyscrasia and non-pulmonary intrathoracic pathologies could be the causes of spontaneous hemothorax. It could be widely seen in young ages (average 22.1 and 34.0 years) and often depends on pleural pathologies. A 17-year-old female patient consulted with the complaints of chest pain on the left side and dyspnea. She did not have tachypnea and tachycardia. In the lung exam, there was no rhonchi but there was crackles. Other system exams were normal. Lung graph findings were compatible with left unilateral hemothorax. In computerized tomography, it was found that there were obvious pleural liquids with the depth of 5.5 cm on the left hemothorax and there were atelectasis in some areas. It was learnt that the patient did not have any diagnosed disease previously, did not use any drugs, did not complain with hemoptysis, and did not have fever in that time. In addition, her family did not have illness and myocardium infarction. Under the consideration of these circumstances, patient was treated to thoracic medicine services with catheter thoracostomy. With expansion deficiency and inappropriate drainage, the patient was implemented left video-assisted thoracoscopic surgery (VATS), pleural biopsy and pleural drainage. In her VATS report, there were pleural liquids, minimal parenchymal units were seperated, thorax was small and diaphragm was elevated and no substantial pleural and parancimal pathologies were not defined. The sample which was taken from the pleural biopsy was fibrinous ploritis and it was compatible with common fresh bleeding. Cytologic findings were compatible chronic inflammatory reaction. Treatment of spontaneous hemothorax differs because of the etiology and in most cases tube thoracostomy could not be enough. Recently, VATS has become popular. In this case, VATS and tube thoracostomy were deployed. In conclusion, hemothorax is an urgent situation which has to be diagnosed immediately. Awareness of causes is highly helpful to diagnose. Even though it is rarely seen in the patients with chest pain and dyspnea, spontaneous hemothorax has to be considered. Treatment methods have to be decided up to vital indications and tube thoracostomy has to be implemented. In the elective situations in which drainage could not be used, VATS would be thought as an alternative option.




J Med Cases. 2015;6(8):333-335
doi: http://dx.doi.org/10.14740/jmc2198w