Introduction: Spontaneous hemothorax is an uncommon pathology. The majority of hemothorax is a result of open or closed thoracic traumas. Thus, spontaneous hemothorax caused by a carcinoid tumor is an exceptional case that has only been reported once in the literature.
Case report: We report the case of a 58 years old Moroccan male patient. The patient was admitted to the emergency room for a sudden left chest pain associated with dyspnea and low abundance hemoptysis. The chest radiography revealed an opacity of the left lower lobe. Chest CT scan revealed an effusion of an average abundance mottled with pulmonary atelectasis. Flexible bronchoscopy was not conclusive. After the thoracentesis failure, a thoracotomy exploration was decided. Spontaneous hemothorax and the presence of a 5cm tumor etiology were intraoperative. Two surgical biopsies were performed with inconclusive extemporaneous readings. A left pneumonectomy with lymphadenectomy was decided to ensure both hemostasis and oncologic resection. The results of histological examination and immune-histo-chemical study were in favor of a carcinoid tumor. The post-operative results were simple.
Conclusion: Spontaneous hemothorax due to the atypical carcinoid tumor is an extremely seldom situation making this case only the second one to be reported in the literature. The peripheral location of the tumor, and the presence of passive pulmonary atelectasis and blood clots, were the factors that made the diagnosis difficult.
Azfar Ali H, Lippmann M, Mundathaje U, Khaleeq G. Spontaneous Hemothorax: A Comprehensive Review. Chest. 2008 Nov 1; 134(5):1056‑1065. https://doi.org/10.1378/chest.08-0725
Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR. Etiology and management of spontaneous haemothorax. J Thorac Dis. 2015 Mar;7(3):520‑6. https://doi.org/10.3978/j.issn.2072-1439.2014.12.50
Kim SH, Seon HJ, Choi Y, Song S. Spontaneous Hemothorax Caused by a Ruptured Atypical Carcinoid Tumor: A Very Rare Case. Iran J Radiol. 2016 Mar; 14(2):e34650. https://dx.doi.org/10.5812/iranjradiol.34650
Ausín P, Gómez-Caro A, Rojo RP, Moradiellos FJ, Díaz-Hellín V, de Nicolás JLM. [Spontaneous hemothorax caused by lung cancer]. Arch Bronconeumol. 2005 Jul;41(7):400‑1. https://doi.org/10.1016/s1579-2129(06)60249-8
Seol H-J, Lee J-H, Lee KY, Kim J-H, Lee N-W, Park H-J. Primary pulmonary choriocarcinoma presenting with a hemothorax. J Thorac Oncol. 2009 May; 4(5):663‑5. https://doi.org/10.1097/jto.0b013e31819cce6c
Fink G, Krelbaum T, Yellin A, Bendayan D, Saute M, Glazer M, et al. Pulmonary carcinoid: presentation, diagnosis, and outcome in 142 cases in Israel and review of 640 cases from the literature. Chest.. 2001 Jun;119(6):1647‑51. https://doi.org/10.1378/chest.119.6.1647
Chen X, Pang Z, Wang Y, Bie F, Zeng Y, Wang G, et al. The role of surgery for atypical bronchopulmonary carcinoid tumor: Development and validation of a model based on Surveillance, Epidemiology, and End Results (SEER) database. Lung Cancer. 2020 Jan;139:94‑102. https://doi.org/10.1016/j.lungcan.2019.11.006
Jeung M-Y, Gasser B, Gangi A, Charneau D, Ducroq X, Kessler R, et al. Bronchial carcinoid tumors of the thorax: spectrum of radiologic findings. Radiographics. Mar- Apr 2002; 22(2):351‑65. https://doi.org/10.1148/radiographics.22.2.g02mr01351
Chou SH, Cheng YJ, Kao EL, Chai CY. Spontaneous haemothorax: an unusual presentation of primary lung cancer. Thorax. 1993 Nov;48(11):1185‑6. https://doi.org/10.1136/thx.48.11.1185
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2020 Fenane H et al.