[Embolisation in spontaneous haemopneumothorax]

Abstract

Background: Spontaneous haemopneumothorax is a rare disorder and is defined as spontaneous pneumothorax associated with the accumulation of more than 400 ml of blood in the pleural cavity.

Case description: A 32-year-old male presented at the emergency department following sudden onset of right-sided stinging chest pain and difficulty in breathing. The chest X-ray showed right-sided hydropneumothorax. A tube thoracostomy was performed, which immediately drained 1500 ml of sanguinolent fluid. The first CT-scan showed no active bleeding. Several hours later the patient became haemodynamically unstable and an additional CT-angiogram was performed. This revealed an extravasation in the area of the second posterior intercostal artery, which was successfully embolised subsequently. This resulted in a haemodynamically stable patient, allowing elective video-assisted thoracic surgery.

Conclusion: Spontaneous haemopneumothorax is a life-threatening disorder. After initial drainage video-assisted thoracic surgery is to be preferred to conservative treatment or thoracotomy. However, it is necessary for the patient to be haemodynamically stable. In this case intervention radiology contributed to a minimally invasive approach. This therefore also merits consideration as a therapeutic option.