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Abstract
A 20-year-old male is presented with hemoptysis since 3 months. Plain chest X-ray and computed tomography (CT) chest at that time
showed bilateral hilar shadows. Recent X-ray showed a huge right-sided well-defined opacity. CT chest and magnetic resonance angiography
were ordered for him revealing a huge intrapulmonary hematoma.
q 2003 Elsevier B.V. All rights reserved.
Keywords: Spontaneous pulmonary hematoma
3. Discussion
Fig. 1. (a) The first CT chest 3 months before. (b) Recent chest X-ray. (c) Very little if any is written or known about the
Recent CT chest shows a huge intrapulmonary hematoma with an aneurysm spontaneous pulmonary hematoma. It should be suspected
inside. (d, e) MRA showing the hematoma and the aneurysm inside it. in a patient with bleeding tendency. It should be
differentiated from a lung tumor. Its diagnosis, anesthesia,
Doppler ultrasound revealed a free flow within this mass. operative and postoperative management are challenging.
Echocardiography showed calcific pericardium and dilated
pulmonaries.
His physical examination showed no abnormalities.
Blood chemistry and serology were normal apart from References
very low prothrombin concentration (34%). Tuberculin
and fibreoptic bronchoscopy (FOB) were done as our [1] Trinkle JK, Richardson JD, Franz JL. Management of flail chest
routine in cases of hemoptysis. It was negative apart from without mechanical ventilation. Ann Thorac Surg 1975;19:355.
some old blood trickling through the right upper lobe [2] Mathai M, Byrd Jr RP, Roy TM. The posttraumatic pulmonary mass.
J Tenn Med Assoc 1996;89:41.
bronchus and BAL (brush and lavage were done through
[3] Colebunders R, Parizel P, De Backer W, De Schepper A, Vermeire P.
the FOB). They were negative. CT guided biopsy Pulmonary haematoma caused by oral anticoagulant therapy. Report of
suggested a fibrous tumor compatible with fibrous a case. Acta Radiol Diagn (Stockholm) 1983;24:445.
histiocytoma. General anesthesia and muscle paralysis [4] Nakayama DK, Ramenofsky ML, Rowe MI. Chest injuries in
were done and the patient was intubated with a Double childhood. Ann Surg 1989;210:770.
lumen endotracheal tube. After pleural adhesions were [5] Stellin G. Survival in trauma victims with pulmonary contusion. Am
Surg 1991;57:780.
dissected, a well-circumscribed lobulated mass of
[6] Obretenov E, Petrov D, Alaidzhiev G, Plochev M. Surgical treatment of
15 £ 10 £ 8 cm3 in the anterior segment of the right post-traumatic intrapulmonary haematomas (Article in Bulgarian).
upper lobe was found. The right upper lobe was resected. Khirurgiia (Sofiia) 2002;58:24.
Pathological examination revealed a pulmonary hematoma [7] Besson A, Saegesser F, Color atlas of chest trauma and associated
(Fig. 2). injuries, vol. 1. Oradell, NJ: Medical Economics; 1983.