Abstract Post-lobectomy hemopneumothorax accounts for less than one percent of all complications and typically occurs within one day postoperatively. Delayed incidences can present up to two weeks. Vigilant follow-up is crucial with high-risk patients. These include rib fracture, older age, emphysema, chronic bronchitis, smoking history, initial minimum hemothorax or pneumothorax, and the need for invasive ventilation. We present a case of a 63-year-old Black female with a history of hypertension who presents with worsening dyspnea, productive cough, and pleuritic chest pain. She had adenocarcinoma of the left upper lung with mediastinal and left hilar lymph nodes involvement, and without distant metastasis. Four cycles of neoadjuvant therapy with cisplatin, pemetrexed, and pembrolizumab were performed. She underwent robotic-assisted left upper lobectomy with mediastinal lymphadenectomy. The postoperative course was complicated by a small, stable left apical pneumothorax. Upon presentation for this admission, however, she was tachypneic, tachycardic, and saturating poorly on two liters of oxygen. She had an elevated WBC, procainamide, and lactic acid. Urine analysis did not indicate a urinary tract infection. Chest X-ray showed a large pneumothorax and an air-fluid level, indicating hydrothorax. Due to clinical presentation, laboratory, and imaging findings, superimposed community-acquired pneumonia was suspected. Broad-spectrum antibiotics, including those covering Methicillin-resistant Staphylococcus aureus and Pseudomonas species, were initiated due to her immunocompromised state. The respiratory culture grew pansensitive Streptococcus pneumoniae, and the blood culture showed no growth after one week. She did not require pressor support. A chest tube was placed in the left pleural space, and 300cc of bloody pleural fluid was drained. Pleural study showed exudative effusion with many RBCs, indicating hemothorax. Delayed hemoneumothorax, defined as the symptomatic accumulation of blood and air within the pleural space after one to two days postoperatively, is extraordinarily rare. So much so that there is no definitive incidence or prevalence in the current literature. Recognition of this condition is essential, as delayed diagnosis can lead to severe hypoxic and hypercapnic respiratory failure, and in more severe cases, hemorrhagic and obstructive shock in the setting of compressive etiology. Patients at risk for delayed hemopneumothorax, including rib fracture, older age, emphysema, chronic bronchitis, smoking history, and initial minimum hemothorax or pneumothorax, should be followed up postoperatively with chest x-ray at two to three days, and again at one to two weeks after the initial procedure. This abstract is funded by: None
Yin et al. (Fri,) studied this question.