Indicators of haemothorax in patients with spontaneous pneumothorax

Objectives: To identify indicators and possible risk factors of haemothorax in patients with spontaneous pneumothorax. Methods: All patients presenting to the emergency department of Chi-Mei Foundation Medical Center, Tainan, Taiwan with primary spontaneous pneumothorax between 1 January 1997 and 31 December 2002 were screened for inclusion in the present study. Of the 211 patients who qualified, eight had spontaneous haemopneumothorax (SHP) (3.79%). The clinical data and demographic characteristics of these patients were similar to those of patients with spontaneous pneumothorax without haemothorax (SP). Results: All eight SHP patients were thin and young men (mean age 24 years and mean weight 56.1 kg). Seven were smokers. The patients with SHP were taller that the patients with SP (177.4 cm v 170.3 cm, respectively; p<0.01), and tended to have a lower body mass index (BMI) (17.9 kg/m² 19.6 kg/m², respectively; p = 0.06) and higher heart rate (101.0 v 88.0 beats/min, respectively; p = 0.09). Clinically, patients with SHP were more likely to have dyspnoea compared with SP patients (62.5% v 26.6%, respectively; p = 0.04) and lower levels of haemoglobin (12.8 v 14.7 g/dl, respectively; p = 0.01) and haematocrit (38.1% v 44.1%, respectively; p<0.01). Chest x rays revealed pleural effusion in all patients with SHP but in none with SP. Conclusions: Patients with SHP are taller, with lower levels of haemoglobin and haematocrit, and are more likely to have dyspnoea than patients without haemothorax. The chest x ray finding of pneumothorax with an ipsilateral air-fluid level is a strong indicator of SHP.