Abstract
A-35-year-old man, who had sudden onset of chest pain and dyspnea after sneezing, was brought into the prior hospital by ambulance, and was diagnosed as having right tension pneumothorax. When a chest tube was inserted, a massive bloody fluid with air was drained. The patient was diagnosed with spontaneous hemopneumothorax and was transferred to our institution. We diagnosed the case as obstructive shock due to tension hemopneumothorax based on his dynamic state and the findings of X-rays. We inserted an additional chest tube immediately, when his dynamic state was improved while bloody fluid was persistently drained. Enhanced computed tomography showed massive right-sided pleural effusion with intrathoracic extravasation near the right pulmonary apex, and his dynamic state became worse again. Emergency video-assisted thoracoscopic surgery (VATS) was thus performed for complicated hemorrhagic shock due to hemopneumothorax. Intraoperative findings showed active bleeding from the teared aberrant vessel existing on the parietal pleura near the apex and ruptured bulla. The hemostasis by cauterization, partial resection of the pulmonary apex including both ruptured and non-ruptured bullae, and evacuation of hematoma were performed. After the operation he recovered promptly and was discharged from our institution on the hospital day 8 following removal of the chest tube on the day 6.
