Abstract
A recent study highlighted the significance of ruptured bullae in the azygoesophageal recess (AER) in patients with secondary spontaneous pneumothorax. Herein we report a case of spontaneous hemopneumothorax due to a ruptured bulla in the AER. A 67-year-old man who developed sudden right chest pain at rest followed by transient loss of consciousness was brought into our hospital by ambulance. He had been given warfarin after aortic valve replacement and his platelet level was low due to chronic hepatitis C. He was diagnosed with right spontaneous hemopneumothorax with hypovolemic shock. During emergent surgery, we confirmed bleeding from a torn adhesion in the apical parietal pleura and a bulla in the AER which might cause spontaneous pneumothorax. Hemostasis was achieved with electrocautery, and excision of the bulla was performed using an endoscopic stapling device. Bleeding and air leak did not recur after the surgery. Surgeons should check a bulla in the AER, even in a patient with spontaneous hemopneumothorax, in order not to overlook a source of air leakage.
