Hemothorax is a life threatening condition that usually caused by trauma. However it may also occur, rarely, following intra-abdominal hemorrhage such as in ruptured aneurysm and abdominal surgery. Here, we report a case of ectopic pregnancy presenting as spontaneous hemothorax.
A 35 years old lady, Para 2 presented to emergency department with syncopal attack and abdominal pain. Last menstrual period was 10 days prior. She had a history of laparoscopic cholecystectomy the same year. She was pale, tachycardic and hypotensive on assessment with reduced air entry on right side of lung and tenderness at suprapubic and epigastric pain. Chest x-ray showed haziness on right side with pleural effusion. Chest tube inserted and drained 1.8L fresh blood. Urine pregnancy test was positive Bedside scan showed empty uterus and free fluid in abdominal cavity. She underwent exploratory laparotomy and left total salphingectomy. A total of 5 litres of blood clots was evacuated from hemiperitoenum.
DISCUSSION & CONCLUSION
Spontaneous hemothorax caused by ruptured ectopic is very rare with only a few cases reported in literature review thus far. It can be hypothesized that increase in intraabdominal pressure caused by hemoperitoneum gave rise to in abnormal communication through diaphragmatic pores and fenestrations resulting in a massive hemothorax in this patient. Another cause of diaphragmatic defects maybe due to laparoscopic cholecystectomy that the patient underwent previously.
This case represents a rare complication of ectopic pregnancy thus highlighting the high index of suspicion in women of child bearing age and the timely treatment of this condition.
Ectopic pregnancy presenting as hemothorax The American Journal of Surgery
MD Homayoon Ganji, MD, FACS Arthur Vidrine Jr1970 Volume 120, Issue 6, Pages 807–809