Spontaneous tension haemopneumothorax

Abstract

We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such case reported.Aetiology and current approach to spontaneous haemothorax are discussed briefly.

Figure 1

Erect chest radiograph showing pneumothorax occupying upper third of left lung field with some mediastinal shift and basal opacification.

Figure 2

Computerised tomography of the thorax with contrast showing vascular abnormality in the left apical area adjacent to second and third thoracic vertebrae.