Spontaneous Hemopneumothorax: a Rare but Life-threatening Entity

Objectives: Spontaneous hemopneumothorax (SHP) is a rare disorder, complicating 1-12% of patients with spontaneous pneumothorax. We conducted a retrospective review in order to study this potentially life-threatening condition and compared our experience with reports in the international literature.

Methods: Between 1970 and 2000, 3489 patients were treated in our department with spontaneous pneumothorax. Seventy-one of them (2%), 63 men and 8 women, aged between 13 and 80 years, presented SHP. Patients presented dyspnea and chest pain. In the majority, chest X-ray confirmed the diagnosis of hydropneumothorax.

Results: All our patients were initially treated with tube thoracostomy or thoracocentesis. Conservative treatment alone was effective in 16 cases (22.5%). Among the other 55 patients (77.5%), 28 (39.4%) were operated on an emergency basis since they were in shock, while 27 (38%) were electively led to surgery for clot evacuation, resection of the bulla, ligation of the adhesion between the parietal and visceral pleura and irrigation of the pleural cavity through thoracotomy. Postoperative course was uneventful and the patients were discharged from the hospital within 7-12 days.

Conclusions: (1) SHP is a rare clinical entity that can lead to potentially life-threatening complications. (2) Early thoracotomy should be considered once the diagnosis of SHP is confirmed.