Kuriakose Milta, Khanna Arjun, Talwar Deepak
Metro Centre for Respiratory Diseases, Metro Multispecialty Hospital, Noida, Uttar Pradesh, India.
Lung India. 2017 May-Jun;34(3):283-286. doi: 10.4103/lungindia.lungindia_6_16.
Spontaneous hemopneumothorax (SHP) is observed in 3%-7% cases of spontaneous pneumothorax where the tear of an adhesion can lead to bleeding with associated hemothorax. This condition has been reported in patients with hemophilia, sarcoidosis, congenital cystic adenomatoid malformation, systemic lupus erythematosus, etc., Here, we describe an unusual case of acute massive SHP in a 62-year-old male who underwent a percutaneous transluminal coronary angioplasty (PTCA) and presented with worsening dyspnea over the next 3 days. On evaluation, he had a massive hemopneumothorax which was considered to be secondary to the use of anticoagulants during the PTCA procedure. Pleural fluid analysis revealed frank blood and was consistent with the diagnosis of hemothorax. Surprisingly, the pleural fluid cytology revealed malignant cells. As the patient had a normal chest X-ray 3 days ago, thoracoscopic pleural biopsy was taken which confirmed the diagnosis of an epithelioid mesothelioma. Although post-PTCA or mesothelioma-associated hemothorax has been rarely reported, these two conditions have not been associated with SHP. Since the patient had no prior clinicoradiological features of mesothelioma, the procedure, and the anticoagulants probably contributed to the massive and rapid accumulation of blood. The presence of small amount of air added further confusion to the dual etiology and has not been described earlier.
自发性血气胸（SHP）在3%-7%的自发性气胸病例中可见，其中粘连撕裂可导致出血并伴有血胸。血友病、结节病、先天性囊性腺瘤样畸形、系统性红斑狼疮等患者中曾有过这种情况的报道。在此，我们描述一例不同寻常的急性大量SHP病例，患者为一名62岁男性，曾接受经皮腔内冠状动脉成形术（PTCA），术后3天出现呼吸困难加重。经评估，他患有大量血气胸，被认为是PTCA手术期间使用抗凝剂所致。胸腔积液分析显示有明显血液，与血胸诊断相符。令人惊讶的是，胸腔积液细胞学检查发现了恶性细胞。由于患者3天前胸部X线检查正常，遂进行胸腔镜胸膜活检，确诊为上皮样间皮瘤。虽然PTCA术后或间皮瘤相关血胸鲜有报道，但这两种情况均与SHP无关。由于患者此前无间皮瘤的临床放射学特征，手术及抗凝剂可能导致了血液的大量快速积聚。少量气体的存在进一步混淆了双重病因，且此前未见相关描述。
