Cases reported "Hemothorax"

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1/35. rupture of aortic aneurysm with right-sided haemothorax.

    A 62-yr-old male with a history of high blood pressure was admitted for persistent dyspnoea and a right-sided pleural effusion, complicated by a recent episode of shock. There was no history of trauma and the patient denied any thoracic pain. A chest tube was inserted which released nonclotting bloody fluid. A thoracic computed tomographic scan of the chest revealed an aneurysm of the inferior third of the descending thoracic aorta. The patient underwent a successful prosthetic graft replacement. We emphasize that rupture of aortic aneurysms should be considered in the evaluation of spontaneous haemothorax even if it is right-sided and not associated with pain.
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2/35. Hepatocellular carcinoma with metastasis to the rib complicated by hemothorax. An autopsy case.

    A 64-year old man was admitted to our hospital with multiple hepatocellular carcinoma (HCC) lesions in the liver, lung and bone. Three weeks after admission, the patient became complicated with right upper chest pain. A chest radiograph showed a marked increase in right pleural effusion. Thoracentesis demonstrated a hemothorax. Despite treatment with a continuous pleural tap and blood transfusions, the patient's clinical status worsened and he developed severe dyspnea. His right pleural effusion might be considered to be caused by a rupture of the HCC metastasis in the right 2nd rib. The patient died due to respiratory and hepatic failure 26 hours after his occurring the pleural effusion. An autopsy revealed moderately differentiated HCC in the liver, lung and bone. The HCC metastasis of the right 2nd rib was found to have torn the nearby pleura. We described a rare case in which hemothorax was caused by a ruptured rib-based HCC.
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keywords = effusion
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3/35. Hepatocellular carcinoma complicated by hemothorax.

    Although hemoperitoneum is a well-known cause of death induced by rupture of hepatocellular carcinoma (HCC). hemothorax caused by rupture of HCC has not been adequately described. We report here a 64-year-old woman who died of bleeding from pleural wall metastasis of HCC. She presented with liver failure and sudden-onset hypotension, and on the same day, she died of hypovolemic shock associated with liver failure. autopsy revealed HCC metastatic to the lungs and right pleura and 21 of bloody pleural effusion in the right side. The cut surface of the metastatic nodule in the right pleura was filled with coagulated blood and necrotic tissue. We concluded that the pleural metastasis had ruptured and caused the right hemothorax. We discuss reported cases of HCC complicated by hemothorax.
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4/35. hemangiopericytoma of the pleura causing massive hemothorax.

    hemangiopericytoma is an unusual soft tissue tumor. A 54-year-old man presented with sudden onset of chest pain and dyspnea for 1 day. The initial chest x-ray showed a massive left pleural effusion. A contrast-enhanced computed tomographic scan of the chest showed a homogenously enhanced mass in the intrathoracic extrapulmonary space. A tube thoracostomy was performed and hemothorax was confirmed. A posterolateral thoracotomy was performed and a tumor in the parietal pleura of the left chest wall was resected. Grossly, the resected tumor arose from the parietal pleura, and the cut surface was elastic, soft, and pale yellow. There were several cystic formations and hemorrhages. Based on histologic findings, hemangiopericytoma with lower grade malignancy was diagnosed. The patient was alive and free from tumor recurrence 1 year after surgery. Intrathoracic extrapulmonary hemangiopericytoma is extremely rare, and surgical excision is the treatment of choice. Adjuvant chemotherapy or radiotherapy is indicated because of the high risk of recurrence and potential malignancy.
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keywords = effusion
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5/35. A 73-year-old man with chronic lymphocytic leukaemia and a haemorrhagic pleural effusion.

    A 73-year-old man presented with haemorrhagic pleural effusion, having been diagnosed with chronic lymphocytic leukaemia (CLL). The differential diagnosis of haemorrhagic pleural effusion is considered. tuberculosis and pleural infiltration of CLL are considered most likely. Pleural biopsy confirms the diagnosis of pleural involvement of CLL in this case. Although pleural involvement of CLL has been reported several times the presentation of pleural effusion as the first symptom of CLL has not previously been described.
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keywords = effusion
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6/35. Fatal inhalational anthrax with unknown source of exposure in a 61-year-old woman in new york city.

    A 61-year-old woman who was a new york city hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as dna amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environmental samples from the patient's residence and workplace, no mechanism for anthrax exposure has been identified.
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keywords = effusion
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7/35. Uterine fibroid: an unusual cause of recurrent haemorrhagic pleural effusion.

    A 51-year-old woman presented with dyspnoea due to pleural effusion, which repeatedly reaccumulated rapidly after tapping. A pelvic mass was present and she was considered to have disseminated ovarian malignant tumour. Total hysterectomy with bilateral salpingo-oophorectomy was performed, and the tumour was shown to be a necrotic uterine fibromyoma. After the operation the patient has been well, with no recurrence of the effusion. This is the twelfth reported case of the association of hydrothorax with uterine fibromyoma, and is a form of the rare pseudo-Meigs' syndrome.
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keywords = effusion
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8/35. False positivity of tumor markers in pleural fluid of traumatic hemothorax.

    Various biochemical parameters of pleural fluid have been employed to identify malignant effusions. However, many of them are also elevated in patients with nonmalignant conditions. We report on a patient with traumatic hemothorax, showing high pleural fluid concentrations of ferritin, tissue polypeptide antigen, and cancer antigen 125. This patient's pleural fluid also contained high levels of bilirubin and many macrophages containing phagocytized red blood cells, suggesting a local metabolism of hemoglobin. Our case confirms that some tumoral markers can give false positive results and suggests that their significance must be evaluated differently in bloody pleural effusions as compared with non-bloody pleural effusions.
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ranking = 3
keywords = effusion
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9/35. Solitary fibrous tumor of the pleura with hemothorax at the thoracic apex.

    A 31-year-old man was referred to our hospital with a diagnosis of a left lung mass and substantial pleural effusion. 1,300 mL of blood was drained. Chest computed tomography (CT) and magnetic resonance imaging (MRI) revealed a hypervascular, round shaped mass, 9 cm in diameter occupying the left thoracic apex. The mass was broad-based, arising from the area of antero-lateral parietal pleura at the level of the thoracic apex and the first rib. The tumor was successfully resected via median sternotomy and left first intercostal thoracotomy without either claviculectomy or claviculotomy. For the complex surgical access and the tumor's hypervascularity, a careful operative procedure was needed to avoid massive bleeding. The tumor was diagnosed microscopically and immunohistochemically as a solitary fibrous tumor of the pleura and did not meet the criteria for malignancy.
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ranking = 1
keywords = effusion
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10/35. An adult case of Bochdalek hernia complicated with hemothorax.

    A 53-year-old female with mild shock due to vomiting and abdominal pain visited the emergency room of our hospital. Chest X-ray on admission showed a large amount of left pleural effusion. Thoracentesis revealed hemorrhagic pleural effusion. An upper gastrointestinal series showed interruption of the upper gastric body, but the anal side was not visualized. Contrast X-ray examination of the thoracic cavity via the drainage tube demonstrated intrathoracic herniation through the diaphragm. These findings suggested gastric impaction in the foramen of Bochdalek, and thoracotomy was immediately performed. A black-colored stomach and greater omentum, suggesting necrotic changes, were observed in the thoracic cavity, and there was bleeding from the greater omentum. Resection of the necrotic organs and closure of the hernial orifice were followed by good recovery.
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ranking = 2
keywords = effusion
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