J Thorac Cardiovasc Surg 2005;129:234-235
© 2005 The American Association for Thoracic Surgery
Reply
Kenichi Okubo, MD,
Toshihiro Okamoto, MD,
Jun Isobe, MD,
Yoichiro Ueno, MD
General Thoracic Surgery, Gifu National Hospital, Gifu, Japan
Chronic expanding hematoma was first described by Reid and colleagues in 19801 and reported to occur in many locations. Although most hematomas resolve spontaneously, a few persist for long periods as slowly expanding, space-occupying masses. In the entity of chronic expanding hematoma of the thorax, the hematoma develops in the pleural space rather than in the pulmonary parenchyma. The hematomas are known to expand 30 years or more after medical or surgical treatment for tuberculosis. The patient usually showed mediastinal compression or chest wall protrusion. Although our patient presented with a sudden onset of hemoptysis, she had shown chest wall protrusion by the intrathoracic and also extrapulmonary hematoma for several months, which is essential for the diagnosis of this entity.
In our patient, emergency bronchoscopy revealed contralateral spread of hemoptysis, which was shown in Figure 1, A.2 Because of the almost complete compression of the destroyed right lung by the hematoma, the patient required a pneumonectomy to survive.
The surgical procedure was intentionally delayed for several days until the left-side spread of the hemoptysis decreased. Median sternotomy was the way to access the hilum directly without compressing the mediastinum through a massive hematoma. In the letter by Dr Sersar and associates, their experience of pulmonary hematoma was shown with some images. However, the chronic expanding hematoma of the thorax is quite different from intrapulmonary hematoma in both clinical course and presentation. Further comparative discussion of treatments does not make sense with different diseases.
References
- Reid JD, Kommareddi S, Lankerani M, Park MC. Chronic expanding hematomas: a clinicopathologic entity. JAMA 1980;244:2441-2442.[Abstract]
- Okubo K, Okamoto T, Isobe J, Ueno Y. Rupture of a chronic expanding hematoma of the thorax into lung parenchyma. J Thorac Cardiovasc Surg 2004;127:1838-1840.[Free Full Text]
