Tuberc Respir Dis.  2008 Jan;64(1):48-51. 10.4046/trd.2008.64.1.48.

A Case of Chronic Expanding Hematoma with Initial Presentation as Massive Hemotpysis through Bronchopleural Fistula in the Thorax

• Jeon EK
• Chung MK
• Kim GM
• Kang JY
• Park HJ
• Kim SJ
• Lee SY
• Moon HS
• Song JS
• Park SH
• Kim YK

• KMID: 1478142
• DOI: http://doi.org/10.4046/trd.2008.64.1.48

Abstract

Chronic expanding hematoma of the thorax is a specific subtype of the chronic empyema. It presents as a slowly expanding intrathoracic mass which result in dyspnea or recurrent hemoptysis. The symptoms develop months or years after tuberculous pleurisy, trauma or surgery. Usually, it shows three common findings: a giant mass lesion in the thorax, some surrounding calcifications, the absence of signs or symptoms of infection. We report a case of chronic expanding hematoma of the thorax, initially presenting as massive hemoptysis through bronchopleural fistula which resulted in radiologic findings of new air-fluid level within the previous pleural lesion filled with unknown materials.

Keyword

Chronic expanding hematoma; Bronchopleural fistula; Air-fluid level; Thorax

MeSH Terms

Dyspnea
Empyema
Fistula
Hematoma
Hemoptysis
Thorax
Tuberculosis, Pleural

Figure

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  Figure 1 Chest X-ray before 3 months of hospitalization (A) shows a well-defined large mass shadow in the right lower lung field. On admission, chest X-ray taken after massive hemoptysis (B) demonstrates a decreased mass shadow with newly developed air-fluid level which finding is suggestive of intrathoracic bleeding.

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  Figure 2 Chest CT performed from three months previously (A, B) shows a large ovoid non-enhancing inhomogenous mass with nodular-calcifications in the right posterior and lower pleura, surrounded by egg shell calcification.

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  Figure 3 On admission, chest CT (A, B) reveals that there are loss of material and concurrently gain of air-fluid level within the intrathoracic mass-like lesion and bronchopleural fistula (arrow) newly develops in the right lung, which findings verify that some amount of blood in the lesion disappear through the fistulous tract during massive hamoptysis.

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