Page 191 - Livre électronique du Congrès CNP 2021

MANAGEMENT OF HAEMOTHORAX WITH

CONCOMITANT PNEUMOTHORAX : EXPERIENCE
WITH 7 CASES
P116 1. M.Abdennadher,1.K Ouaghlani, 1.A Ghazaouni, 1. H.Zribi, 1.S.Zairi, 1. I. Bouacida, 2.

A. Ayadi-Kaddour, 3. H. Smadhi, 4. M. Touaibia, 4. S..Ouerghi, 1.A. Marghli

1. SERVICE DE CHIRURGIE THORACIQUE ET CARDIOVASCULAIRE. HOPITAL ABDERRAHMANE MAMI.
ARIANA. 2. SERVICE D’ANATOMOPATHOLOGIE. HOPITAL ABDERRAHMANE MAMI. ARIANA. 3. SERVICE
DE PNEUMOLOGIE IBN NAFIS. HOPITAL ABDERRAHMANE MAMI. ARIANA. 4. SERVICE D’ANESTHESIE
REANIMATION CHIRURGICALE. HOPITAL ABDERRAHMANE MAMI. ARIANA FACULTE DE MEDECINE DE
TUNIS. UNIVERSITE TUNIS EL MANAR

Introduction:

Spontaneous haemothorax(SH) corresponds to an accumulation of blood in the pleural cavity in
the absence of trauma. It is a rare clinical entity whose etiologies are poorly known.Approximately
5% of patients with pneumothorax have concomitant haemothorax with an amount of blood in the
pleural space.The clinical presentation varies from completely asymptomatic to haemorrhagic
shock. Indeed, the respiratory and hemodynamic consequences are likely to aggravate the
prognosis of the underlying pathology. This justifies the rapid adoption of a comprehensive
therapeutic strategy combining an assessment of severity, appropriate guidance, symptomatic
management (oxygen therapy, transfusion) and etiologic management in which thoracic surgeons
are the main actors.

Methods:

We analyzed retrospectively the medical data of patients admitted to thoracic and cardiovascular
surgery department , in Abderrahmen Mami hospital of Ariana during 2019 and who had
presented pneumothorax concomitant with SH . We picked out their clinical, biological, and
perioperative course characteristics.We excluded patients with traumatic haemothorax or isolated
spontaneous haemothorax.

Results:

We analyzed data from 7 patients. The sex ratio was 6/1. The mean age was 31 years old. Three
patients among seven had hemodynamic instability. Five patients were operated urgently and two
patients were managed conservatively. The most common source of bleeding in (4/7 of patients)
resulted from the shearing of the adhesions between the parietal and the visceral pleura. In
perioperative ,blood accumulated in the pleural space was under systemic pressure, and its origin
was the subclavian artery in all patients.

Conclusion:

SH is a rare clinical entity that can lead to potentially life-threatening complications. Its association
with pneumothorax worsens the prognosis and the amount of bleeding in absence of lung
tamponade. Rupture of pleural adhesions is the most common source of bleeding. The thoracic
surgeons should be familiar with this condition, its multiple causes and management, paying

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