Spontaneous hemopneumothorax

We retrospectively studied the treatment for 14 patients of spontaneous hemopneumothorax. The mean age was 31.2 years, ranging from 21 to 63 years, and only one female patient was included in this study. For most patients it was the first episode of pneumothorax, and grade III collapse was most common. The site of bleeding was an interrupted stump of the funicular structure from the parietal pleura in 10 patients and from a ruptured bulla in 2 patients. Conversion from VATS to thoracotomy was needed for patients with a long delay between onset and operation, because it was difficult to remove massive blood clots from the trocar port by suction. Reoperation was needed for one patient who had VATS 15 days after onset, because of the prolonged air leakage. The results of VATS were better than those for open thoracotomy with respect to duration of drainage, postoperative stay and duration of analgesic use. We conclude that prompt decision for the surgical treatment is desirable considering blood loss, persistent air leakage and pulmonary re-expansion. VATS may be considered as feasible treatment for patients with spontaneous hemopneumothorax in their early stage.