title: Case study: Idiopathic hemothorax in a patient with status asthmaticus.
abstract: Idiopathic spontaneous hemothorax has been rarely described in the literature.
  
  
  
  A case of status asthmaticus and spontaneous hemothorax is described in a 29-year-old female of African descent who presented to the emergency room after 2 days of severe cough productive of yellow sputum, otalgia, sore throat, subjective fevers, chills, headache, progressive wheezing, chest tightness and dyspnea. She had a history of 7 years of asthma and was non-adherent with her controller asthma medications. Prophylactic subcutaneous administration of enoxaparin 40 milligrams was initiated upon hospitalization. The patient initially had a normal chest radiograph but subsequently developed a large, left hemothorax that required tube thoracostomy placement followed by video-assisted thoracoscopic surgery (VATS).
  
  
  
  The patient was transferred to the Intensive Care Unit (ICU) and tube thoracostomy resulted in evacuation of 1,400 milliliters of blood-like fluid, which had a pleural fluid hematocrit greater than 50% of the serum hematocrit. A contrast-enhanced computed tomography (CT) scan of the chest did not reveal any source for the bleeding and a technetium bone scan of the chest was normal. The patient required transfusion of 5 units of packed red blood cells. She was then taken to the operating room for VATS because of continued chest tube drainage (3,200 milliliters of fluid over a 48-hour period).
  
  
  
  The etiology of the hemothorax was unknown despite surgical exploration but was felt to be secondary to cough and bronchospasm associated with status asthmaticus.
authors.affiliation: a Department of Allergy/Immunology , University of South Florida , Tampa , FL , USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ricketti
authors.affiliation: b Mercer Allergy & Pulmonary Associates, LLC, Pulmonary , Trenton , NJ , USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Unkle
authors.affiliation: c University of South Florida, Allergy/Immunology , Tampa , FL , USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lockey
authors.affiliation: d Department of Internal Medicine , Seton Hall University , Wayne , NJ , USA.
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Cleri
authors.affiliation: b Mercer Allergy & Pulmonary Associates, LLC, Pulmonary , Trenton , NJ , USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Ricketti
mesh_terms: D000328:Adult; D001986:Bronchial Spasm / Q000150:complications; D003371:Cough / Q000150:complications; D005260:Female; D006491:Hemothorax / Q000209:etiology* / Q000601:surgery; D006801:Humans; D013224:Status Asthmaticus / Q000150:complications*; D013907:Thoracostomy; D014057:Tomography, X-Ray Computed
keywords: Hemothorax; Legionella pneumonia; idiopathic hemothorax; medication non-adherence; pneumonia; status asthmaticus