A case of left hemothorax that progressed to intra-abdominal bleeding by rupture of an ovarian cyst through a diaphragm fossula

Abstract

A 22–year–old woman with lower abdominal pain consulted our emergency hospital for intra–abdominal bleeding after being referred from a local hospital. Abdominal enhanced CT showed a left ovarian cyst, extravasation from an adjacent blood vessel, and intra–abdominal bleeding. She developed anemia and dyspnea following admission. Chest X–ray and CT showed severe left hemothorax and she was identified as having sanguineous pleural fluid by the insertion of a thoracic catheter. She underwent laparoscopic surgery, and the bleeding point was identified as the rupture of an ovarian cyst. Total fluid passage through the thoracic catheter was 650 ml, and intra–operative abdominal bleeding was 500 ml. The properties of both were the same. We noted the leakage of contrast media through a diaphragm fossula, from the thoracic cavity to the abdominal cavity. We thought that intra–abdominal bleeding into the thoracic cavity occurred through the diaphragm fossula, leading to the rise in intra–abdominal pressure by intra–abdominal bleeding and negative pressure in the thoracic cavity due to respiratory movement. Only 2 case reports of the kind were found in Japan, including the present case. We present this case together with a review of the literature.