Khallikane Said, Bentahar Amine, Reda Mounir, Elabdi Monsef, Salek Monsif
Cardiothoracic Anesthesiology, Avicenna Military Hospital, Marrakech, MAR.
Medicine and Pharmacy, Cadi Ayyad University, Marrakech, MAR.
Cureus. 2025 Feb 21;17(2):e79422. doi: 10.7759/cureus.79422. eCollection 2025 Feb.
Acute myeloid leukemia (AML) is a malignant hematologic disorder characterized by bone marrow failure and an increased risk of hemorrhagic complications due to thrombocytopenia, coagulopathy, and hyperfibrinolysis. While AML is associated with bleeding tendencies, massive spontaneous hemothorax (SH) is an exceedingly rare and often fatal manifestation. We report the case of a patient who presented with acute chest pain, dyspnea, and hemodynamic instability, ultimately diagnosed with AML-associated hemothorax. Imaging confirmed a large pleural effusion, and pleural fluid analysis revealed a hematocrit consistent with hemothorax. Bone marrow biopsy established a diagnosis of acute myelomonocytic leukemia (AML M4, FAB classification) with myelodysplasia-related changes (WHO classification). Management included urgent tube thoracostomy, correction of coagulopathy, and fluid resuscitation, with surgical intervention considered based on bleeding progression. Despite supportive measures, the prognosis in AML-associated hemothorax remains poor due to the underlying malignancy and hemorrhagic complications. During disease progression, the development of spontaneous hemopericardium further worsened the prognosis, leading to severe hemodynamic deterioration and increased mortality risk. This case underscores the importance of early recognition, rapid diagnosis via ultrasound and CT imaging, and a multidisciplinary treatment approach involving hematologists, intensivists, and thoracic specialists. Given the rarity of this complication and the absence of standardized guidelines, further studies are needed to refine diagnostic and therapeutic strategies for AML-related hemothorax.
急性髓系白血病（AML）是一种恶性血液系统疾病，其特征为骨髓衰竭，以及因血小板减少、凝血病和高纤维蛋白溶解导致出血并发症的风险增加。虽然AML与出血倾向有关，但大量自发性血胸（SH）是一种极其罕见且往往致命的表现。我们报告了一例患者，该患者出现急性胸痛、呼吸困难和血流动力学不稳定，最终被诊断为AML相关血胸。影像学检查证实有大量胸腔积液，胸腔积液分析显示血细胞比容与血胸相符。骨髓活检确诊为急性粒单核细胞白血病（AML M4，FAB分类）伴骨髓发育异常相关改变（WHO分类）。治疗措施包括紧急胸腔闭式引流、纠正凝血病和液体复苏，并根据出血进展情况考虑手术干预。尽管采取了支持性措施，但由于潜在的恶性肿瘤和出血并发症，AML相关血胸的预后仍然很差。在疾病进展过程中，自发性心包积血的出现进一步恶化了预后，导致严重的血流动力学恶化和死亡风险增加。该病例强调了早期识别、通过超声和CT成像快速诊断以及血液科医生、重症监护医生和胸科专家参与的多学科治疗方法的重要性。鉴于这种并发症的罕见性以及缺乏标准化指南，需要进一步研究以完善AML相关血胸的诊断和治疗策略。
