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CASE REPORT
Year : 2020  |  Volume : 16  |  Issue : 4  |  Page : 933-934

Utility of medical thoracoscopy in diagnosis and treatment of hemothorax due to carcinoma: A case report


Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

Date of Submission31-Oct-2016
Date of Decision18-Jul-2017
Date of Acceptance26-Jul-2017
Date of Web Publication13-Sep-2017

Correspondence Address:
Qing-Hua Liu
Department of Respiratory Medicine, Shandong Provincial Hospital Affiliated to Shandong University, 9677 Jingshi East Road, Jinan 250014
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.JCRT_1222_16

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 > Abstract 


Hemothorax cannot always be treated by thoracic surgeon. Rapidly improved interventional pulmonology broadens the application of medical thoracoscopy. We attempt to share our experiences of medical thoracoscopy for hemothorax and discuss the value of medical thoracoscopy in pleural diseases. We reported a 76-year-old male with hemothorax who was cured by medical thoracoscopy under local anesthesia together with argon plasma coagulation. Moreover, final pathological diagnosis was acquired as pleural sarcomatoid carcinoma. The unusual manifestation under medical thoracoscopy of such a relative rare disease was also described in this paper. The medical thoracoscopy could be used successfully for hemothorax instead of treating with surgeon, especially for those who cannot tolerate procedure of operation or surgical thoracoscopy.

Keywords: Case report, hemothorax, medical thoracoscopy, pleural disease, sarcomatoid carcinoma


How to cite this article:
Liu QH, Lin DJ. Utility of medical thoracoscopy in diagnosis and treatment of hemothorax due to carcinoma: A case report. J Can Res Ther 2020;16:933-4

How to cite this URL:
Liu QH, Lin DJ. Utility of medical thoracoscopy in diagnosis and treatment of hemothorax due to carcinoma: A case report. J Can Res Ther [serial online] 2020 [cited 2020 Sep 30];16:933-4. Available from: http://www.cancerjournal.net/text.asp?2020/16/4/933/214515




 > Introduction Top


Hemothorax is an emergency situation usually treated by thoracic surgeon. Occasionally, drug treatment is the only way we have to rely on if the patient is too weak to tolerate surgery. With rapidly improved application of the interventional pulmonology, recently, medical thoracoscopy might bring some light on it. We would like to report a case with hemothorax cured by medical thoracoscopy and share some of our experiences.


 > Case Report Top


A 76-year-old male patient was brought to our hospital with a chief complaint of progressive dyspnea and anemia for 1 month. The patient had no symptoms such as fever, chest pain, and hemoptysis. His vital sign is stable. Physical examination and chest computed tomography (CT) showed right pleural effusion [Figure 1]. He was treated previously in a primary medical care institution for drainage of pleural effusion for about 3 weeks. About 450 ml bloody fluid was drained out per day. The examination of hemoglobin (Hb) in pleural effusion showed 54 g/L. All the results of the fluid examination including the tumor cell and acid-fast bacillus were negative. Tumor marker test in serum and pleural effusion was also negative. His situation deteriorated quickly with a rapid decrease of Hb, and blood transfusion was given [Figure 2]. Moreover, his medical history showed a record of coronary heart disease and hypertension for >10 years. Moreover, he was diagnosed with cerebral infarction and treated with intracranial vascular stent implantation 4 years ago. Then, clopidogrel hydrogen sulfate was given daily till thoracentesis was performed and changed into aspirin. Surgeon was also consulted, and no surgical intervention was recommended at the time.
Figure 1: Computed tomography examination (a and b) before medical thoracoscopy; (c and d) 7 days later after medical thoracoscopy

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Figure 2: Result of hemoglobin examination

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After 24 h of discontinuation of aspirin administration, rigid medical thoracoscopy was performed under local anesthesia. Mild adhesions and multiple bleeding nodules were found [Figure 3]. Needle aspiration from the bleeding nodule showed no severe bleeding. Then, biopsy and argon plasma coagulation (APC) were followed [Figure 3]. A total of 150 ml bloody fluid was drained out and a chest tube was placed. Several days later, no fluids were drained out and the value of Hb stopped decreasing. One week later, chest CT scan showed less pleural effusion [Figure 1]. The final pathological diagnosis was pleural sarcomatoid carcinoma. None complication was encountered. Two months later, the patient showed improved Hb and remained stable under chemotherapy.
Figure 3: (a and b) thoracoscopic findings; (c and d) argon plasma coagulation

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 > Discussion Top


Hemothorax is frequently caused by trauma and treated by surgeon with drainage, thoracotomy, or video-assisted thoracoscopic surgery.[1],[2],[3] Medical thoracoscopy under local anesthesia together with APC or other instruments assistance can provide another useful option. Medical thoracoscopy was often limited in the field of diagnosis of pleural disease in the past.[4],[5] The rapid development in instruments broadens the usage of medical thoracoscopy for the treatment of pleural diseases. Despite the advantages of minimum invasiveness, tolerableness, and fewer complications, exploration of the applications for medical thoracoscopy is still needed, especially its therapy value for pleural diseases.[5] Here, we provide another new minimal invasive and effective way for hemothorax.

Our experiences in such a case are as the follows. First, one should be with cautions to avoid heavy bleeding during any maneuver, especially before biopsy. We used needle aspiration before biopsy in this case as well as 0.5 mg epinephrine injection to the lesions. Second, any performance must be very accurate. Certain expertise is needed to guide such a procedure. Finally, we recommend utilizing rigid thoracoscopy instead of flexible thoracoscopy under such a circumstance.

Hemothorax can be caused by carcinoma. Medical thoracoscopy could be used as an alternative method, especially for those who cannot tolerate procedure of operation or surgical thoracoscopy.

Financial support and sponsorship

This study was supported by Critical R&D Project of Shandong Province, 2015 (2015GSF118184).

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Ahmad T, Ahmed SW, Soomro NH, Sheikh KA. Thoracoscopic evacuation of retained post-traumatic hemothorax. J Coll Physicians Surg Pak 2013;23:234-6.  Back to cited text no. 1
    
2.
Billeter AT, Druen D, Franklin GA, Smith JW, Wrightson W, Richardson JD, et al. Video-assisted thoracoscopy as an important tool for trauma surgeons: A systematic review. Langenbecks Arch Surg 2013;398:515-23.  Back to cited text no. 2
    
3.
Aljehani Y, Makhdom F, Albuainain H, El-Ghoniemy Y. Primary spontaneous haemopneumothorax: An overlooked emergency. Indian J Chest Dis Allied Sci 2014;56:113-5.  Back to cited text no. 3
    
4.
Blanc FX, Atassi K, Bignon J, Housset B. Diagnostic value of medical thoracoscopy in pleural disease: A 6-year retrospective study. Chest 2002;121:1677-83.  Back to cited text no. 4
    
5.
Lee P, Mathur PN, Colt HG. Advances in thoracoscopy: 100 years since Jacobaeus. Respiration 2010;79:177-86.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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