1. Shqiptar Demaçi*, Saudin Maliqi*, Selajdin Bajrami*,
Inefficacity of thoracic drain or continual bleeding from pleural laceration at massive spontaneous hematopneumothorax. Case report
Shqiptar Demaçi*, Saudin Maliqi*, Selajdin Bajrami*,
Agreta Gashi**, Isak Maxhuni**
Dpt. of Thoracic Surgery, Clinic of Surgery, UClC of Kosova, Prishtina *
Dpt. of Anestesiology and Reanimation ** 1

2. Causes of spontan.hemothorax
Neoplasia (primary or metastatic)
Blood dyscrasias, including complications of anticoagulation
Pulmonary embolism with infarction
Torn pleural adhesions in association with spontaneous pneumothorax
Bullous emphysema
Necrotizing infections
Tuberculosis
Pulmonary arteriovenous fistulae
Hereditary hemorrhagic telangiectasia
Nonpulmonary intrathoracic vascular pathology (eg, thoracic aortic aneurysm, aneurysm of the internal mammary artery)
Intralobar and extralobar sequestration
Abdominal pathology (eg, pancreatic pseudocyst, splenic artery aneurysm, hemoperitoneum)
Catamenial 2

3. Abstract:
Spontaneous hematothorax is rare occurred complication of tearing of pleural adhesion during spontaneous pneumothorax.
At Emergency Centre (EC) at UCLC-Kosova,Prishtina patient Xh. K. 23 year- old is admitted as urgent case, drained in thorax in one regional Hospital in Kosova hospitalised there two day before with diagnosis: Hemato-pneumothorax spontaneus lat.sin. There were evacuated in start 900 ml fresh blood, redrained tomorrow and evacuated plus 350 ml blood. In admission in EC are registered parameters of arterial pressure 125/ 78 mm Hg, periferic pulse 126 /min, oxygen saturation with 89%, conscious, difficult breathing, pale skin, agitative. In drainage collecting subaqual bottle (Pleurevac), is counted 200 ml blood and is seen drain 24 Fr in situ in left chest. Drain is replaced with another of 32 French grade, and now evacuate plus 200 ml blood. Hematocrite is measured 3

4. Blood producing dynamics are measured 100 ml /1 hour- for 4 hour
Blood producing dynamics are measured 100 ml /1 hour- for 4 hour. So is given indication for urgent thoracotomy for hemostasis . Intraoperatory is seen and evacuated big coagulated amount of blood (circa 300 ml) and slowly active bleeding from laceration of parietal pleura which is cauterised.
Also is done apical resection of small blebses and after that parietal pleurectomy and abrasion of other part of pleura. In ward was ordinate cristalloides, analgetics, two doses of blood. After 4 days the drain was removed and patient is released in fifth day with expanded lungs with hemoglobine - count 97 g / L and hematocrite The next chest X-ray show expanded lung. 4

5. Ptx 1 our after beginning of pain and dispnoa-collpas.lung5

6. Day after Drained left but still collapsed left lung – chest x ray done in regional hospital6

7. In admmitance on emergency ward-two day after drainage of pleura but still collpased left lung7

8. Intraoperationem 8

9. cauterised pleural laceration
Inefficacity of thoracic drain or continual bleeding from pleural laceration at massive spontaneous hematopneumothorax
cauterised pleural laceration
signs of ineff. drain 9

10. 3-d day after th- tomy.Two drains in situ –left and expanded lungs10

11. 9-th day after operation – expanded lungs11

12. Conclusion:
Even inefficacity of drain aspiration could collect big amount of pleural blood, slowly bleeding from pleural adhesion in this case is most beleiving cause of massive bleeding from pleura.
These cases stress the need for early recognition and management of a potentially life-threatening event.
Key word: Hemothorax spontaneous, tube thoracostomy drainage, urgent thoracotomy
Correspondent author: Shqiptar Demaçi MD, thoracic surgeon
UClC of Kosova,Prishtina
Tel mob 12

13. Literature: 1. Hemothorax: eMedicine Thoracic Surgery M.C.Mancini 2009
2.Meysman M, Verhaeghe W, Sacre R, et al. Emergency treatment of life-threatening spontaneous haematopneumothorax. Eur J Emerg Med. Dec 1996;3(4):274-6. [Medline].
3. Martinez FJ, Villanueva AG, Pickering R, et al: Spontaneous hemothorax. A report of 6 cases and review of the literature. Medicine 1992;71:354–368
4.Edinburgh KJ, Chung MH, Webb WR: CT of spontaneous hemothorax from intrapleural rupture of a pulmonary arteriovenous malformation. Am J Roentgenol 1998;170:1399–1400. 
5.Hsu NY, Hsieh MJ, Liu HP, et al: Video-assisted thoracoscopic surgery for spontaneous hemopneumothorax. World J Surg 1998;22:23–26 13

14. Thank you ! 14