Chest
Volume 137, Issue 2, February 2010, Pages 480-483
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Postgraduate Education Corner
Pulmonary and Critical Care Pearls
Spontaneous Hemothorax and Recurrent Hemoptysis in a 26-Year-Old Man With Skin Lesions

https://doi.org/10.1378/chest.09-1030Get rights and content

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Physical Examination

On physical examination, the patient appeared comfortable and in no acute respiratory distress. Vital signs on presentation were significant for a heart rate of 100, a respiratory rate of 30, and oxygen saturation of 96% on 2-L nasal cannula. His body habitus was remarkable for short stature (5 ft 1 in), and his facial examination was significant for flattened nasal bridge and slightly low-set ears. Chest examination revealed dullness to percussion and decreased air entry over the lower half of

Discussion

In most cases, hemothorax is the result of trauma or a complication of a procedure, such as placement of a central venous catheter or thoracentesis. Hemothorax, as a result of tearing of adhesions between pleural layers or rupture of highly vascularized bullae, can be a complication of spontaneous pneumothorax. Although rare, spontaneous hemothorax does occur (Table 1). After ruling out pneumothorax and necrotizing infections, the differential diagnosis of spontaneous hemothorax in an otherwise

Clinical Pearls

  • 1.

    The presence of spontaneous hemothorax in a young, healthy patient should prompt an investigation for inherited coagulopathies, neoplastic disease, and vascular and connective tissue anomalies.

  • 2.

    The vascular type of EDS is a rare but serious heritable defect in type 3 collagen expression encoded by the COL3A1 gene.

  • 3.

    Despite a penetrance of 100%, the age of detection of type 4 EDS may vary from early childhood into adulthood.

  • 4.

    During the physical examination, the vascular type of EDS does not usually

Acknowledgments

Financial/nonfinancial disclosures: The authors have reported to the CHEST the following conflicts of interest: Dr Siner receives funding from the Yale Clinical and Translational Service Award to investigate the role of growth factors in human sepsis. Drs Selim, Lane, and Rubinowitz have reported no conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).

1

Drs Selim and Lane contributed equally to this work.

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