Published online September 18, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1268-e1270 (doi:10.1542/peds.2006-0766)
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EXPERIENCE & REASON

Spontaneous Hemopneumothorax in Children: Case Report and Review of Literature

Magimairajan Issaivanan, MD, MPHa,b, Purnima Baranwal, MDb, Sunil Abrol, MDc, Gurjot Bajwa, MDc, Mary Baldauf, MDb and Mayank Shukla, MDb

a Divisions of Pediatric Pulmonary Medicine
c Surgery,
b Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, New York

ABSTRACT

Spontaneous hemopneumothorax is rare, occurs in young adolescents, and can be life threatening secondary to massive bleeding. An adolescent with spontaneous hemopneumothorax and shock managed by tube thorascostomy is described here. We compared our case with published data of spontaneous hemopneumothorax in the pediatric age group. Spontaneous hemopneumothorax involves the accumulation of air and blood in the pleural space in the absence of trauma or other obvious causes. Spontaneous hemopneumothorax is usually seen in adolescents, more common in males than females. The common clinical features of spontaneous hemopneumothorax include dyspnoea and chest pain, and 30% present with hypovolemic shock. The bleeding can result from a torn adhesion between the parietal and visceral pleurae, from a rupture of vascularized bullae, or from torn congenital aberrant vessels. Over the last 6 decades, the treatment has progressed from the thoracotomy to minimally invasive techniques such as video assisted thoracoscopic surgery, with great reduction in mortality and recurrence rates. Although a rare entity, diagnosis of spontaneous hemopneumothorax must be considered in young adolescents presenting with spontaneous onset of chest pain and dyspnoea with radiograph findings of hydropneumothorax and/or signs of shock.

Key Words: spontaneous pneumothorax • SP • chest pain • dyspnea • video-assisted thoracoscopic surgery • VATS

Abbreviations: SHP, spontaneous hemopneumothorax • VATS, video-assisted thoracoscopic surgery • SP, spontaneous pneumothorax

Accepted May 15, 2006.