Page 182 - Livre électronique du Congrès CNP 2021

UNUSUAL CASE OF PRIMARY SPONTANEOUS
P110 R. Ben Jazia 1, J. Ayachi2, I. Kharrat1, A. Kacem1, F. Chatbouri1, F. Chortani1, E.
HEMOPNEUMOTHORAX

Mnasser1, A. Maatallah1

1- IBN EL JAZZAR REGIONAL HOSPITAL, PULMONOLOGY DEPARTMENT - KAIROUAN (TUNISIA), 2- IBN
EL JAZZAR REGIONAL HOSPITAL, EMERGENCY DEPARTMENT - KAIROUAN (TUNISIA)

A 31-year-old male, chronic smoker, without chronic medical illnesses, was referred to a
peripheral hospital with sudden onset of right-sided chest pain and shortness of breath. On
presentation, he was in acute respiratory failure and collapse. There was no history of traumas,
surgical procedures, or other serious events. Chest X ray revealed a large complete and
compressive right pneumothorax. The patient was then transferred to our university hospital by
the ERT team after an urgent needle decompression.

Upon arrival at our emergency department, a thoracic computed tomography (CT) scan was
performed showing a large right hydropneumothorax with total collapse of lung. A 24-Fr thoracic
drain was inserted. 900 ml of blood and air was evacuated immediately, and then the outflow of
the blood stopped.

A contrast-enhanced thoracic CT scan was performed revealing no contrast extravasation signs,
no underlying mass or vascular malformation with a right apical dystrophic bullous emphysema,
small fluid collection in the lower right pleural cavity without air and a thoracic drain in place.

In front of the stabilization of his vital signs and the interruption of the blood outflow from the
drainage tube, we continued conservative therapy with chest drainage.

After 20 hours, the patient developed hemorragic shock and drop of hemoglobin level. An urgent
chest X-ray was performed revealing an increasing of the right pleural effusion. In front of the
persistence of hemodynamic instability despite fluid challenge and blood transfusion, the patient
was transferred to the cardiothoracic surgical ward. A video-assisted thoracoscopic surgery
(VATS) was performed. Approximately 800 ml of blood and clots in the thoracic cavity and a
collapsed right lung with several apical bullae were observed. After evacuation of the blood clot
and the resection of the bullae, the hemostasis was achieved and two chest drain were placed.
They were then removed after 2 days in front of the non recurrence of air and blood flow, the
complete re-expansion of the right lung and the increase of hemoglobin level. The patient was
then discharged on the 10th post-operative day.

SHP is a well-documented disorder, however it is rarely encountered in clinical practice. It can be
life threatening, so a prompt diagnosis and therapeutic intervention are required.

The conservative therapy that consists in chest drainage, is often performed to achieve
hemostasis. However, the success rate of this strategy is lower comparing to VATS.

SHP patients who had a shorter hospital stay, less bleeding as well as less frequent transfusion,
were those who underwent early VATS rather than those who underwent conservative therapy.

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