1/2. Spontaneous haemopneumothorax: are guidelines overdue?Spontaneous life threatening haemopneumothorax is an unusual but treatable cause of unexpected circulatory collapse in young patients. Two case histories are presented to illustrate the management of this condition. diagnosis and initial management depends on early recognition of the clinical pattern by accident and emergency (A&E) staff and/or hospital physicians. Problems may arise for two reasons. Firstly, as the incidence of life threatening spontaneous haemopneumothorax is low, admitting medical staff may not have experienced this condition in the absence of trauma. Secondly, unlike surgeons, staff in these specialties are unlikely to have received training of either traumatic or spontaneous haemopneumothorax. The cases illustrate potential problems. Not only early recognition of the clinical pattern but also proactive intervention in the A&E department are necessary before referral to a cardiothoracic surgeon. Furthermore, we suggest treatment would be improved by the introduction of management guidelines.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/2. Spontaneous haemopneumothorax: a rare clinical entity.A 39 yr old man presented with a spontaneous pneumothorax. On initial pleural drainage 120 ml of haemorrhagic fluid were collected. Twenty four hours, after re-expansion of the lung, shock developed and 1,200 ml of haemorrhagic fluid were spontaneously collected. The diagnosis haemopneumothorax was considered and at operation a bleeding vessel, which originated from the parietal pleura, was located and coagulated. The occurrence of an air fluid line at radiological examination, the development of a haemorrhagic pleural effusion and shock should alert the physician of this entity. This case stresses the importance of early recognition and surgical intervention because of the possible lethal evolution.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |