An analytical review of spontaneous haemopneumothorax.

In 1900 Newton Pitt wrote, " There is no reference to spontaneous haemopneumothorax in the Index Catalogue of the U.S. Library, nor is it discussed in any of the standard treatises on medicine, in either English, French, or German." It has remained little discussed even in specialized textbooks although about 150 cases, including the present three, have been recorded. Both spontaneous haemopneumothorax and spontaneous. haemothorax are complications of spontaneous pneumothorax, of which careful follow-up (Kjaergaard, 1932; Perry, 1939) has failed to reveal any correlation with tuberculosis. It is also probable that spontaneous haemothorax may at times have no coexistent or immediately antecedent spontaneous pneumothorax. Both Pitt (1900) and Rolleston (1900) realized that spontaneous haemopneumothorax was potentially serious. Each reported a fatal case. Noteworthy contributions to this subject include those of Hyde and Hyde (1951) with 12 case reports, Ross (1952) with six, Louria (1938) with five, Moser (1951) with four, and Hopkins (1937), Hartzell (1942), Hansen (1949), Harrell (1949), Nalls and Matthews (1949), Rottenberg and Golden (1949), Eidinger and Rubin (1952), and Borrie (1953) each recording three cases. This subject has been briefly reviewed (Jones and Gilbert, 1936; Hopkins, 1937; Hartzell, 1942; Helwig and Schmidt, 1947; Nario, Bermuidez, and Espasandin, 1949; Deucher, 1950; Fusia and Cook, 1952; and Eidinger and Rubin, 1952). Some authors (Hartzell, 1952; Helwig and Schmidt, 1947; Cuningham, 1950) have also analysed available necropsy data. The literature indicates an overall mortality rate of 15%, although a figure of 25% has been determined previously (Myers, Johnston, and Bradshaw, 1951; Ross, 1952). All these fatality rates are undoubtedly artificially high as the more serious or fatal cases are specially reported, while the milder cases are frequently unrecognized or unrecorded. Most of the fatalities have been relatively immediate. occurring in the first two days. Only 10 cases (Hopkins, 1937; Hartzell, 1942; Crimm, 1948; Dorset and Terry, 1949; Deucher, 1949; Hansen, 1949; Harrell, 1949; Knight and Oelrich, 1949; Freund and Hicks, 1953; Towson, 1954) have been reported in women. Both sides of the chest have been equally involved. Recurrence is quite exceptional, but has been authenticated (Repetti, 1940; Rusby, 1947), while an earlier or later spontaneous pneumothorax has occasionally been described (Rist and Worms, 1940; Hartzell, 1942; Goldman and Roth, 1944; Deucher, 1950). Our three illustrative cases, treated in the past two years, refute its rarity. Chapman (1950) claimed that, in spontaneous pneumothorax, free intrapleural haemorrhage occurs at the onset of pulmonary collapse in about one in eight patients. This frequency is not evident in the larger series of spontaneous pneumothorax. Rottenberg and Golden (1949), for instance, reported that three of 97 consecutive cases of simple pneumothorax had massive haemothorax from which one died, while Hyde and Hyde (1951), in a similar series of 112 cases, found that five of these patients had spontaneous haemopneumothorax. This condition ranks with other forms of internal haemorrhage as a strict emergency. Indeed, our third patient died while too ill for exploratory thoracotomy.