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August 1961

Idiopathic Massive Spontaneous Hemopneumothorax

Arch Surg. 1961;83(2):253-256. doi:10.1001/archsurg.1961.01300140095018

Spontaneous hemopneumothorax was first recognized by Laennec at an autopsy in 1828; Whittaker is credited with first successfully treating this disease, by aspiration, in 1876.1 Intrapleural bleeding is found in association with spontaneous pneumothorax in 3% to 12% of cases.2,3 The amount of bleeding is usually so small as to be of little consequence; hemorrhage has been reported in something over 100 cases.4 Our review of the American and English literature has revealed 23 cases of massive (more than 1,500 ml. blood) hemopneumothorax since 1950.1,2,4-15

Pathogenesis  Pneumothorax, usually incident to rupture of blebs or bullae, is believed to be the initiating factor. With collapse of the lung, visceroparietal adhesions may be torn, providing the source of bleeding, which may be delayed as long as 48 hours. It follows that the vascularity of those adhesions would contribute to the intensity and quantity of blood lost. Hemorrhagic diathesis