Spontaneous Tension Hemothorax in a Patient with Asbestosis

Our plain-English summary of Spontaneous Tension Hemothorax in a Patient with Asbestosis, by T. Suzuki, T. Takada (Clinical Practice and Cases in Emergency Medicine, 2022).

The study

• Authors: T. Suzuki, T. Takada
• Journal: Clinical Practice and Cases in Emergency Medicine
• Published: 2022;6(4):330-332
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Case Presentation: A 75-year-old man with a history of asbestosis presented to the emergency department with sudden-onset dyspnea and hemoptysis, triggered by coughing. The patient was hemodynamically unstable and in respiratory distress. Computed tomography revealed a massive hemothorax on the left side and compression of the descending thoracic aorta. He underwent emergency surgical exploration after decompression by chest tube insertion. The hemothorax was caused by tears in the pleural adhesions due to asbestosis and induced by coughing.

Discussion: Spontaneous hemothorax is a rare subtype of hemothorax. There have been only a few case reports of spontaneous tension hemothorax. In addition to its typical findings, compression of the thoracic descending aorta was observed in our patient. We hypothesize that severely diminished pulmonary compliance contributed to the extremely high intrathoracic pressure, which led to this unusual finding.

In plain English

This article is a case report about one patient. A 75-year-old man with a history of asbestosis, and of cirrhosis with a low platelet count, came to an emergency department with sudden shortness of breath and was coughing up blood. Both had been triggered by coughing. The patient had been exposed to asbestos while working as an air-conditioning engineer 30 years earlier. The article does not name a fiber type. The patient had no history of trauma and was not taking blood thinners. A chest X-ray showed pleural plaques on both sides and a completely clouded left chest. A CT scan showed a massive collection of blood in the left chest (hemothorax) pressing on the descending thoracic aorta. A chest tube drained 1,200 milliliters of blood, and blood pressure rose. Surgery found tears and bleeding in pleural adhesions. The patient was discharged after 26 days and was doing well at one year. The authors concluded that the bleeding came from coughing-induced tears in pleural adhesions due to asbestosis. They hypothesized that severely reduced lung compliance (stiff lungs) contributed to the very high pressure inside the chest.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (a single patient, published as an 'Images in Emergency Medicine' article)
• Who was studied: One 75-year-old man with a history of asbestosis and of cirrhosis with thrombocytopenia (low platelet count), seen in an emergency department
• Exposure: Asbestos exposure during work as an air-conditioning engineer, 30 years before presentation. No fiber type or dose is given.
• Main results:
  • The patient had no trauma history and was not on anticoagulant or antiplatelet therapy
  • On arrival the patient was hemodynamically unstable and in respiratory distress: blood pressure 100/84 mm Hg, pulse 116 per minute, respiratory rate 24 per minute, oxygen saturation 90% on room air
  • The patient's platelet count was 42,000 per microliter
  • Chest radiography showed bilateral pleural plaques, complete opacification of the left thorax, and mediastinal shift toward the right
  • CT showed a massive left hemothorax and compression of the descending thoracic aorta; during CT, systolic blood pressure dropped to 60 mm Hg
  • A chest tube drained 1,200 milliliters of blood from the left thorax, after which blood pressure rose to 98/62 mm Hg
  • Surgical exploration found pleural adhesion tears and bleeding; examination of the torn parietal pleura with plaques showed fibrinous pleuritis
  • A severe reduction in lung (pulmonary) compliance was observed during mechanical ventilation after surgery
  • After 26 days, which included delayed ventilator withdrawal and treatment of a urinary tract infection, the patient was discharged; at one-year follow-up there was no recurrence
• The authors' conclusion: The authors concluded that the hemothorax was caused by coughing-induced tears in pleural adhesions due to asbestosis. They hypothesized that severely diminished lung compliance contributed to the extremely high pressure inside the chest that led to the aortic compression.

Topics

Medical terms in this study, explained in our Lexicon: Hemothorax, Dyspnea, Hemoptysis, Intrathoracic.

Related studies

• Dehydroepiandrosterone inhibits the spontaneous release of superoxide radical by alveolar macrophages in vitro in asbestosis — W.N. Rom, T. Harkin (1991)
• Tranexamic acid treatment of hemothorax in two patients with malignant mesothelioma — W.A. De Boer, M.G. Koolen, et al. (1991)
• Pseudomesotheliomatous Adenocarcinoma Presenting as Hemothorax and Mimicking Mesothelioma: A Case Study — M. Ijim, S. Keddabi, et al. (2026)
• Hemothorax in Dialysis Patients: The Importance of History and Differential Diagnoses — M. Cabrio, M.C. Ribeiro Silva, et al. (2026)
• Lung function 22-35 years after treatment of idiopathic spontaneous pneumothorax with talc poudrage or simple drainage — P. Lange, J. Mortensen, et al. (1988)
• Spontaneous pneumothorax and pulmonary malignant disease--a syndrome sometimes associated with cavitating tumours. Report of nine new cases, four with metastases and five with primary bronchial tumours — F.W. Wright (1976)

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