Case Reports Open access

Right-sided spontaneous, massive hemothorax in a 27-week pregnant lady: a case report

Authors

Published
8 September 2023
Section
Case Reports
DOI
10.4081/ecj.2023.11595

Abstract

Spontaneous, massive hemothorax due to pulmonary varix is an uncommon, yet catastrophic cause of respiratory distress during pregnancy and postpartum. Presentation is often confused with pulmonary embolism, the treatment of which, worsens the condition. Diagnosis is challenging because of the elusive abnormalities on radiographic and bronchoscopic examination. Currently, there are no treatment guidelines for pulmonary varix. A 23-year-old pregnant lady in her second trimester, with intra-uterine fetal demise, presented to our emergency with dyspnoea, fever, and right-sided chest pain for three days. Chest X-ray and therapeutic thoracocentesis revealed massive right-sided hemothorax and computed tomography suggested pulmonary varix as the cause which was managed with emergency chest tube drainage. Massive, spontaneous hemothorax due to pulmonary varix in pregnancy is a rare occurrence, but it requires timely, multidisciplinary assessment and management for the betterment of the mother and the fetus.

Keywords

References

  1. Martinez FJ, Villanueva AG, Pickering R, et al. Spontaneous hemothorax. Report of 6 cases and review of the literature. Medicine (Baltimore) 1992;71:354-68. DOI: https://doi.org/10.1097/00005792-199211000-00003
  2. Doshi HM, Robinson S, Chalhoub T, et al. Massive spontaneous hemothorax during the immediate postpartum period. Tex Heart Inst J 2009;36:247-9.
  3. Yung CM, Bessen SC, Hingorani V, et al. Idiopathic hemothorax. Chest 1993;103:638-9. DOI: https://doi.org/10.1378/chest.103.2.638
  4. KR Graettinger, Avery DM Jr. Spontaneous hemothorax during pregnancy: a comprehensive review of the literature. Available from: https://jfmo.cchs.ua.edu/files/2014/04/MASSIVE-SPONTANEOUS-HEMOTHORAX.pdf
  5. Ali HA, Lippmann M, Mundathaje U, Khaleeq G. Spontaneous Hemothorax: A Comprehensive Review. Chest 2008;134:1056-65. DOI: https://doi.org/10.1378/chest.08-0725
  6. Yamaguchi B, Kodama Y, Watanabe K, et al. Pulmonary varix clearly demonstrated by 3D-CT before pulmonary angiography. Radiol Case Rep 2022;17:4183-7. DOI: https://doi.org/10.1016/j.radcr.2022.08.023
  7. Ebrahimi M, Heydari A, Mazlom R, Mirhaghi A. The reliability of the Australasian Triage Scale: a meta-analysis. World J Emerg Med 2015;6:94–9. DOI: https://doi.org/10.5847/wjem.j.1920-8642.2015.02.002
  8. Patrini D, Panagiotopoulos N, Pararajasingham J, et al. Etiology and management of spontaneous haemothorax. J Thorac Dis 2015;7:520-6.
  9. Bartram C, Strickland B. Pulmonary varices. Br J Radiol 1971;44:927-35. DOI: https://doi.org/10.1259/0007-1285-44-528-927
  10. Kim YH, Marom EM, Herndon JE, McAdams HP. Pulmonary vein diameter, cross-sectional area, and shape: CT analysis. Radiology. 2005;235:43-9; discussion 49-50. DOI: https://doi.org/10.1148/radiol.2351032106
  11. Haddad J, Badran A, Pavão R, et al. Pulmonary varix: A case report. Rev Port Cardiol Engl Ed 2016;35:443.e1-443.e4. DOI: https://doi.org/10.1016/j.repc.2015.10.012
  12. Arnett JC, Patton RM. Pulmonary varix. Thorax 1976;31:107-12. DOI: https://doi.org/10.1136/thx.31.1.107
  13. Berecova Z, Neuschl V, Boruta P, et al E. A Complex Pulmonary Vein Varix - Diagnosis with ECG gated MDCT, MRI and Invasive Pulmonary Angiography. J Radiol Case Rep 2012;6:9-16. DOI: https://doi.org/10.3941/jrcr.v6i12.1017
  14. Agustin M, Shay S, Gonzalez J, et al. Massive pulmonary hemorrhage from bronchial varix. Case Rep Pulmonol 2020;2020:9175785. DOI: https://doi.org/10.1155/2020/9175785
  15. Gleason JB, Shekar SP, Hernandez F, et al. Pulmonary varix: an uncommon pulmonary vascular anomaly. Clin Pulm Med 2017;24:87. DOI: https://doi.org/10.1097/CPM.0000000000000192
  16. Lee HN, Hyun D. Pulmonary arteriovenous malformation and its vascular mimickers. Korean J Radiol 2022;23:202-17. DOI: https://doi.org/10.3348/kjr.2021.0417
  17. Luh SP, Tsao TCY. Video-assisted thoracic surgery for spontaneous haemopneumothorax. Respirology 2007;12:443-7. DOI: https://doi.org/10.1111/j.1440-1843.2006.01008.x
  18. Luh SP. Diagnosis and treatment of primary spontaneous pneumothorax. J Zhejiang Univ Sci B 2010;11:735-44. DOI: https://doi.org/10.1631/jzus.B1000131
  19. Huggins, J. T., Doelken, P., & Sahn, S. A. The unexpandable lung. F1000 Med Reports 2010;2:77. DOI: https://doi.org/10.3410/M2-77

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