title: Assessment of spontaneous hemopneumothorax: Indications for surgery.
abstract: BACKGROUND
  Although spontaneous hemopneumothorax is rare, emergency surgery may be necessary if massive bleeding is present.
  
  
  METHODS
  We examined therapeutic strategies and outcomes as well as background factors in 16 patients with spontaneous hemopneumothorax treated at our hospital between April 2002 and August 2013.
  
  
  RESULTS
  Emergency surgery was performed in 3 patients, all of whom were hemodynamically unstable. Elective surgery was performed in 7 patients, all of whom showed continuous bleeding from a pleural cavity drain. The surgery consisted of intrapleural hematoma removal, hemostasis, and bullectomy; 3-port thoracoscopy was used in all of the surgical cases. Six patients, none of whom showed continuous bleeding, recovered with conservative therapy. Comparing the conservative therapy and surgery groups revealed the mean continuous bleeding volume and total blood loss to be significantly greater in the latter, but no significant difference was noted between the two groups in terms of the initial bleeding volume following tube thoracostomy. None of the cases required a blood transfusion.
  
  
  CONCLUSIONS
  Spontaneous hemopneumothorax is not necessarily an indication for surgery, and even when the initial volume of blood drained through the chest tube is large, some patients can still be treated conservatively with careful monitoring of vital signs and continuous bleeding volumes. However, it is important not to miss the optimal timing of surgery in order to avoid administering unnecessary blood transfusions to young patients.
authors.affiliation: Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan ma03007@yahoo.co.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Inafuku
authors.affiliation: Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Maehara
authors.affiliation: Department of General Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan.
authors.forename: Taketsugu
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Yokohama City University, Yokohama, Japan.
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
mesh_terms: D000293:Adolescent; D000328:Adult; D015505:Chest Tubes; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006406:Hematoma / Q000601:surgery; D006468:Hemopneumothorax / Q000601:surgery / Q000628:therapy*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D035423:Thoracic Cavity / Q000473:pathology / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013906:Thoracoscopy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arteriovenous malformations; hemopneumothorax; lung; thoracic surgery; thoracostomy; video-assisted