Idiopathic Haemopneumothorax

Calvert, Rowland J (1956) Idiopathic Haemopneumothorax. MD thesis, University of Glasgow.

Abstract

The entire literature on idiopathic haemopneumothorax, comprising 240 well-documented case-reports, has been surveyed, analysed and discussed. The author's eight illustrative cases, which are representative of the varied problems, have been separately presented and discussed. For comparative purposes, twelve acceptable published cases of idiopathic haemothorax have been critically considered. With the intent of characterising the entity, idiopathic haemopneumo-thorax, a section has been entirely devoted to statistical analysis, in which the corresponding information on idiopathic pneumothorax has been collaterally scrutinised. These data, which are too extensive for reproduction here, can be conveniently obtained from consultation of Section 2. Available information on the aetio-pathogenesis, clinical features, simulations and complications, laboratory and radiological observations, and treatment has been fully outlined. Certain recent therapeutic applications for selected cases, i.e. emergency thoracotomy to secure haemostasis; pulmonary decortication for clotted haemothorax and fibrothorax; and firbinolytic enzyme-therapy, have been reviewed. Conclusions. (1) Idiopathic haemopneumothorax is an uncommon complication of the not uncommon condition, idiopathic pneumothorax. Indeed, about 5% of idiopathic pneumothoraces are complicated by haemothorax. (2) The hypothesis of an identical aetiology for the idiopathic types of haemopneumothorax, haemothorax and pneumothorax is strongly supported by the evidence presented. Similarly, the pathogeneses are allied. Some cases of idiopathic haemothorax may, in reality, have been instances of haeraopneumo-thorax. (3) Unquestionably, there are two aetiologies, a distant tuberculous and a non-tuberculous type. An over-ready identification with past pulmonary tuberculosis is rebuffed by the fact that about 50% of patients with idiopathic types of haemopneumothorax and pneumothorax exhibit negative responses to standard tuberculin-tests. Nor do non-tuberculous pulmonary infections, as judged by available information, constitute an adequate uniform explanation. It appears irrefutable that the basic lesions, i.e. subpleural bullae, apical scarring and pleural adhesions, are relics of pulmonary infection and it can be safely concluded that both distant tuberculous and non-tuberculous infections are progenitors of an, as yet, undetermined relative proportion of the idiopathic types of haemopneumothorax, haemothorax and pneumothorax. (4) Two main mechanisms in the production of haemopneumothorax have been established. (a) an initial pneumothorax from a ruptured subpleural bleb, with subsequent haemorrhage from stretched and tom pleural adhesions, This explanation, alone, has the merit of satisfactorily accounting for undoubted cases of delayed intrapleural haemorrhage. Here, as in the cases of idiopathic haemothorax, haemorrhage arises mainly, if not entirely, from the parietal tag of the ruptured adhesion. (b) the simultaneous irruption of air and extravasation of blood from a tom emphysematous bulla, without the invocation of torn adhesions. (5) The indications for emergency thoracotomy have been tentatively defined:- (a) an initial haemoglobin value of 50% or less, in the peripheral blood, provided there are still signs of shock. (b) an initial period of four or, at most, six hours for close observation and therapeutic thoracentesis. If, following the transfusion of three pints of blood, in this period, there are no clear signs of improvement, including the blood pressure, immediate thoracotomy is obligatory. Even although the blood pressure has reverted to normal, if a tachycardia exceeding 110 per minute persists, this operation is similarly imperative. (c) the appearance of signs of tension haemopneumothorax, coupled with inconclusive signs that the haemorrhage has ceased. Early and adequate aspiration of intrapleural "blood" constitutes the most important prophylaxis of the disabling complication, fibrothorax, and minimises the total duration of illness. The minimal aim is the conversion of the haemopneumothorax to a pneumothorax.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Keywords: Medicine
• Date of Award: 1956
• Depositing User: Enlighten Team
• Unique ID: glathesis:1956-79752
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 03 Mar 2020 10:39
• Last Modified: 03 Mar 2020 10:39
• URI: https://theses.gla.ac.uk/id/eprint/79752