Hemopneumothorax is a combination of two medical conditions: pneumothorax and hemothorax. Pneumothorax, which is also known as a collapsed lung, happens when there is air outside the lung, in the space between the lung and the chest cavity. Hemothorax occurs when there is blood in that same space. Only about 5 percent of patients with pneumothorax experience hemothorax at the same time.
Hemopneumothorax most often occurs as a result of a wound to the chest, such as from a gunshot, stabbing, or broken rib. This is called traumatic hemopneumothorax. In very rare instances, the condition is caused by other medical conditions, like lung cancer, bleeding disorders, or rheumatoid arthritis. Hemopneumothorax can also occur spontaneously without an apparent cause (spontaneous hemopneumothorax).
To treat hemopneumothorax, the blood and air must be drained from the chest using a tube. Surgery will also be needed to repair any wounds or injuries.
What are the symptoms of hemopneumothorax?
Hemopneumothorax is a medical emergency, so it’s important to recognize its symptoms right away.
- sudden chest pain that gets worse after coughing or taking a deep breath
- difficult or labored breathing (dyspnea)
- shortness of breath
- chest tightness
- tachycardia (rapid heart rate)
- pale or blue skin caused by lack of oxygen
The pain may only occur on both sides or only on the side where the trauma or injury has occurred.
What causes hemopneumothorax?
Hemopneumothorax is most frequently caused by a trauma or blunt or penetrating injury to the chest.
When the chest wall is injured, blood, air, or both can enter the thin fluid-filled space surrounding the lungs, which is called the pleural space. As a result, the functioning of the lungs is disrupted. The lungs aren’t able to expand to let in air. The lungs then shrink down and collapse.
Examples of a trauma or injury that could cause hemopneumothorax include:
- stab wound
- gunshot wound
- puncture from a broken rib
- fall from a significant height
- car accident
- injury from fighting or contact sports (like football)
- puncture wound from a medical procedure, such as a biopsy or acupuncture
When trauma or injury is the cause, the condition is referred to as traumatic hemopneumothorax.
In rare cases, hemopneumothorax may be caused by non-traumatic situations including:
- complications of lung cancer
- rheumatoid arthritis
- systemic lupus erythematosus
- congenital cystic disease of the lung
Hemopneumothorax can also occur spontaneously with no apparent cause. However, this is very uncommon.
How is hemopneumothorax diagnosed?
If you have an injury or trauma to your chest, your doctor may order a chest X-ray to help see if fluid or air is building up within the chest cavity.
Other diagnostic tests may also be performed to further evaluate the fluid in around the lungs, for instance a chest CT scan or an ultrasound. An ultrasound of the chest will show the amount of fluid and its exact location.
Treatment for hemopneumothorax is aimed at draining the air and blood in the chest, returning the lung to normal function, preventing complications, and repairing any wounds.
Thoracostomy (chest tube insertion)
The main treatment for hemopneumothorax is called chest tube thoracostomy. This procedure involves placing a hollow plastic tube between the ribs into the area around the lungs in order to drain the air and blood. The tube may be connected to a machine to help with the drainage. After your doctor is sure that no more fluid or air needs to be drained, the chest tube will be removed.
People with a large wound or injury will most likely need surgery in order to repair the damaged tissue. They may also need one or more blood transfusions if they’ve lost a lot of blood.
Before the thoracostomy procedure, depending on the cause of your condition, your doctor may also give you prophylactic antibiotics to help prevent bacterial infections. Your doctor may also prescribe pain medications to help with any pain before and after your surgery.
Complications of hemopneumothorax
Complications of hemopneumothorax include:
- serious infections, such as pneumonia
- hemorrhagic shock
- cardiac arrest
- empyema, a condition in which pus gathers in the pleural space; empyema is usually caused by pneumonia
- respiratory failure
In addition, people who’ve had hemopneumothorax are at risk of having another episode if the opening in the lung won’t fully close.
Hemopneumothorax is a potentially life-threatening condition and needs to be treated right away for the best outlook.
If the condition was caused by a trauma or injury to the chest, the outlook will depend on the severity of the injury. Spontaneous cases of hemopneumothorax have an excellent prognosis once the fluid and air is removed from the chest. In one small study, all four patients with spontaneous hemopneumothorax recovered completely and their lungs expanded fully after the episode.
In general, hemopneumothorax won’t cause any future health complications after it’s treated. However, there’s a small chance of reoccurrence. The use of minimally invasive techniques, like thoracostomy and video-assisted surgery, has led to a reduction in mortality and recurrence rates.