Bilateral spontaneous hemopneumothorax in a young male with underlying bullous lung disease: A rare and life-threatening clinical entity

• Author Details:   
• Vishnudas S Telbhare
• Atul Deshpande
• Pradip B Dalvi
• Gyanshankar P Mishra ^*

Spontaneous hemopneumothorax is an exceedingly rare and potentially life-threatening manifestation of spontaneous pneumothorax, often associated with subpleural blebs or bullous lung disease. The condition necessitates prompt recognition and intervention, with the insertion of an intercostal drain (ICD) as the initial treatment of choice. However, the role and optimal timing of surgical intervention, including video-assisted thoracoscopic surgery (VATS), remain subjects of ongoing clinical debate. VATS is increasingly employed for both diagnostic and therapeutic purposes in these patients.
We present the case of a previously healthy 17-year-old male who presented to the emergency department with acute onset of pleuritic chest pain and dyspnea. Chest radiography revealed a hydropneumothorax, and pleural fluid analysis confirmed a hemopneumothorax, for which immediate ICD placement was performed. The patient was initially managed conservatively. However, during the same hospitalization, he developed a sequential contralateral hemopneumothorax, necessitating urgent thoracoscopy with wedge resection and insertion of an additional ICD. This case underscores the complexity of managing bilateral spontaneous hemopneumothorax and highlights the increasing role of VATS in both diagnosis and treatment.

Keywords:  Spontaneous hemopneumothorax, Primary spontaneous pneumothorax, Intercostal drain (ICD), Video-assisted thoracoscopic surgery (VATS), Thoracoscopy, Pleuritic chest pain, Dyspnea, Hydropneumothorax, Pleural fluid analysis, Bilateral hemopneumothorax, Wedge resection, Emergency management, Surgical intervention, Adolescent pneumothorax, Thoracic surgery.