Two Cases of Spontaneous Hemopneumothorax Treated by Emergency Video-assisted Thoracic Surgery (VATS)

Abstract

We have performed video-assisted thoracic surgery (VATS) for two patients with spontaneous hemopneumothorax. Patient 1, a 37-year-old man, visited the emergency clinic in our hospital complaining of chest pain. Chest X-ray film and CT scan revealed pulmonary collapse and hemopneumothorax in the left lung. Large quantities (1,100ml) of dark-red blood drained after placement of a trocar. Three hours after admission, outpouring of fresh blood (300ml) occurred from the thoracic cavity and he went into hemorrhagic shock. Emergency surgery with VATS for hemostasis was performed. Bleeding from a cord arisen from the parietal pleura was stopped by clipping. The patient's post-operative course was uneventful, and he was discharged on the 8^th postoperative day. Patient 2, a 44-year-old man, visited the emergency clinic in our hospital complaining of chest pain. Chest X-ray film and CT scan revealed pulmonary collapse and hemopneumothorax in the left lung. Large quantities (870ml) of dark-red blood drained 5 hours after admission. Emergency surgery with VATS was performed to stop bleeding and to remove a pulmonary cyst. Bleeding from the parietal pleura at the apex was stopped by soft coagulation. The patient's post-operative course was uneventful, and he was discharged on the 5^th postoperative day. Emergency surgery as well as strict monitoring after admission is recommended for spontaneous hemopneumothorax because it entails a risk of causing hemorrhagic shock.