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PurposePost-operative pain after video-assisted thoracoscopic surgery is often treated using thoracic epidural analgesics or thoracic paravertebral analgesics. This article describes a case where a thoracic disc herniation is treated with a thoracoscopic microdiscectomy with post-operative thoracic epidural analgesics. The patient developed a bupivacaine pleural effusion which mimicked a hemothorax on computed tomography (CT).MethodsThe presence of bupivacaine in the pleural effusion was confirmed using a high performance liquid chromatography method.ResultsThe patient underwent a re-exploration to relieve the pleural effusion. The patient showed a long-term recovery similar to what can be expected from an uncomplicated thoracoscopic microdiscectomy.ConclusionA pleural effusion may occur when thoracic epidural analgesics are used in patents with a corridor between the pleural cavity and epidural space.

Purpose The aim of this case report is to report that delayed hemothorax is possible after anterior vertebral body tethering (aVBT) and to illustrate the course of treatment. Methods We present a 15-year-old boy with adolescent idiopathic scoliosis who underwent an anterior thoracoscopic assisted vertebral body tethering who developed a massive right-sided hemothorax 12 days post-operatively. A chest tube was placed to drain the hemothorax and later required embolectomy with tissue plasminogen activator (TPA) to drain the retained hemothorax. Results At 1 month follow up post discharge the patient was asymptomatic, and radiograph did not demonstrate evidence of residual hemothorax and scoliosis. We have followed this patient for 5 years postoperative and he continues to do well clinically and radiographically. Conclusions Pulmonary complications are a known drawback of anterior thoracoscopic spinal instrumentation. Delayed hemothorax is possible after aVBT. In the case of a retained hemothorax, chest tube treatment with TPA is a safe and effective method of embolectomy.

Case Report A 43-year-old female with history of plasmacytoma (treated with radiation therapy in 2013), asthma, and allergic rhinitis presented with acute onset right-sided pleuritic chest pain that woke her from sleep. Thoracic endometriosis syndrome is diagnosed clinically when females experience chest pain, pneumothorax, hemothorax, hemoptysis, or lung nodules around the time of menses (as much as 3 days before or 7 days after).

Retained hemothorax (RH) is a commonly encountered and potentially severe complication of intrapleural bleeding that can organize with lung restriction. Early surgical intervention and intrapleural fibrinolytic therapy have been advocated. However, the lack of a reliable, cost-effective model amenable to interventional testing has hampered our understanding of the role of pharmacological interventions in RH management. Here, we report the development of a new RH model in rabbits. RH was induced by sequential administration of up to three doses of recalcified citrated homologous rabbit donor blood plus thrombin via a chest tube. RH at 4, 7, and 10 days post-induction (RH4, RH7, and RH10, respectively) was characterized by clot retention, intrapleural organization, and increased pleural rind, similar to that of clinical RH. Clinical imaging techniques such as ultrasonography and computed tomography (CT) revealed the dynamic formation and resorption of intrapleural clots over time and the resulting lung restriction. RH7 and RH10 were evaluated in young (3 mo) animals of both sexes. The RH7 recapitulated the most clinically relevant RH attributes; therefore, we used this model further to evaluate the effect of age on RH development. Sanguineous pleural fluids (PFs) in the model were generally small and variably detected among different models. The rabbit model PFs exhibited a proinflammatory response reminiscent of human hemothorax PFs. Overall, RH7 results in the consistent formation of durable intrapleural clots, pleural adhesions, pleural thickening, and lung restriction. Protracted chest tube placement over 7 d was achieved, enabling direct intrapleural access for sampling and treatment. The model, particularly RH7, is amenable to testing new intrapleural pharmacologic interventions, including iterations of currently used empirically dosed agents or new candidates designed to safely and more effectively clear RH.

Retained hemothorax (RH) is relatively common after chest trauma and can lead to empyema. We hypothesized that patients who have surgical fixation of rib fractures (SSRF) have less RH and empyema than those who have medical management of rib fractures (MMRF). Admitted rib fracture patients from January 2009 to June 2013 were identified. A 2:1 propensity score model identified MMRF patients who were similar to SSRF. RH, and empyema and readmissions, were recorded. Variables were compared using Fisher exact test and Wilcoxon rank–sum tests. One hundred thirty-seven SSRF and 274 MMRF were analyzed; 31 (7.5%) had RH requiring 35 interventions; 3 (2.2%) SSRF patients had RH compared with 28 (10.2%) MMRF (P = .003). Four (14.3%) MMRF subjects with RH developed empyema versus zero in the SSRF group (P = .008); 6 (19.3%) RH patients required readmission versus 14 (3.7%) in the non-RH group (P = .002). Patients with rib fractures who have SSRF have less RH compared with similar MMRF patients. Although not a singular reason to perform SSRF, this clinical benefit should not be overlooked.

Although rib fractures are a risk factor, not all rib fracture patients will develop delayed hemothorax. This study aimed to evaluate risk factors which can identify rib fracture patients in the emergency department who may develop delayed hemothorax. Adult patients seen in the emergency room between January 2016 and February 2021 with rib fractures caused by blunt chest trauma were included in this retrospective observational study. Patients who underwent chest tube insertion within 2 days and those without follow-up chest radiographs within 2–30 days were excluded. We used a stepwise backward-elimination multivariable logistic regression model for analysis. A total of 202 patients were included in this study. The number of total (P < 0.001), lateral (P = 0.019), and displaced (P < 0.001) rib fractures were significantly associated with delayed hemothorax. Lung contusions (P = 0.002), and initial minimal hemothorax (P < 0.001) and pneumothorax (P < 0.001) were more frequently associated with delayed hemothorax. Age (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.00–1.06, P = 0.022), mechanical ventilator use (aOR 9.67, 95% CI 1.01–92.75, P = 0.049), initial hemothorax (aOR 2.21, 95% CI 1.05–4.65, P = 0.037) and pneumothorax (aOR 2.99, 95% CI 1.36–6.54, P = 0.006), and displaced rib fractures (aOR 3.51, 95% CI 1.64–7.53, P = 0.001) were independently associated with delayed hemothorax. Age, mechanical ventilation, initial hemo- or pneumothorax, and displaced rib fractures were risk factors for delayed hemothorax. Patients with these risk factors, and especially those with ≥2 displaced rib fractures, require close chest radiography follow-up of 2–30 days after the initial trauma.

Background Penetrating neck injuries in the area between the clavicles and the cricoid cartilage sometimes cause intrathoracic problems such as pneumothorax or hemothorax. Injuries of subclavian vessels were reported as a cause of hemothorax caused by penetrating neck injuries. Coil embolization and hemostasis with electrocautery were reported as treatment. Herein we present a case of hemothorax caused by penetrating neck injury, which was treated with pleural dome laceration covering performed using video-assisted thoracic surgery. Case presentation A 68-year-old Japanese woman presented to our hospital after sustaining a self-inflicted stab wound to her left neck and chest with a kitchen knife. She was in hemorrhagic shock due to hemothorax caused by penetrating neck injury. We performed video-assisted thoracic surgery and stopped bleeding with pleural dome laceration covering. We chose the treatment instead of coil embolization or hemostasis with electrocautery because the bleeding vessel was unclear. Conclusion Pleural dome laceration covering was effective for hemothorax that was caused by penetrating neck injury when the bleeding vessel was unclear.

On chest CT scan, vascular lung abnormalities were very similar in the 4 patients, including peripheral medium and small pulmonary artery branches aneurysms, one of them also having renal and diaphragmatic artery aneurysms (Fig. 1). Alain Combes View author publications You can also search for this author in PubMed Google Scholar Contributions CD contributed to data collection, data interpretation, writing; SB contributed to data collection and radiological interpretation, writing; GH contributed to data analysis, writing and revising the work, AR contributed to design, radiological data analysis, revising the work, AC contributed to design, data analysis, writing and revising the work. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. Crit Care 24, 638 (2020). https://doi.org/10.1186/s13054-020-03359-7 Download citation * Received: 21 September 2020 * Accepted: 23 October 2020 * Published: 06 November 2020 * DOI: https://doi.org/10.1186/s13054-020-03359-7 [RAW_REF_TEXT] Research Letter [/RAW_REF_TEXT] [RAW_REF_TEXT] Open Access [/RAW_REF_TEXT] [RAW_REF_TEXT] Published:06 November 2020 [/RAW_REF_TEXT] Spontaneous hemothorax in 4 COVID-19 ARDS patients on VV-ECMO revealing pulmonary artery aneurysms [RAW_REF_TEXT] Cyrielle Desnos ORCID: orcid.org/0000-0003-4098-64361 , [/RAW_REF_TEXT] [RAW_REF_TEXT] Samia Boussouar2,3 , [/RAW_REF_TEXT] [RAW_REF_TEXT] Guillaume Hekimian1 , [/RAW_REF_TEXT] [RAW_REF_TEXT] Alban Redheuil2,3 & [/RAW_REF_TEXT] [RAW_REF_TEXT] Alain Combes1,3 [/RAW_REF_TEXT] Critical Care volume 24, Article number: 638 (2020) Cite this article [RAW_REF_TEXT] 665 Accesses [/RAW_REF_TEXT] [RAW_REF_TEXT] 6 Altmetric [/RAW_REF_TEXT] [RAW_REF_TEXT] Metrics details [/RAW_REF_TEXT] COVID-19 pneumonia is a cause of severe ARDS.