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Solitary pulmonary hematoma is a rare consequence of blunt chest trauma. Moreover, there has been no reported case of solitary pulmonary hematoma radiographically diagnosed as a posterior mediastinal tumor. We present the case of a 63-year-old man who was referred for an oval-shaped opacity at the left paraspinal area on a chest X-ray. Chest computed tomography showed a well-circumscribed posterior mediastinal tumor on the left paraspinal lesion with extrapleural sign and callus formation on the left ribs posteriorly (7th to 11th ribs). The tumor was thoracoscopically confirmed to be a subpleural pulmonary tumor of the left lower lobe, and wedge resection was performed. Histological examination confirmed the diagnosis of pulmonary hematoma. On reviewing the callus formation of the ribs, which was suggestive of rib fractures, the pulmonary hematoma was determined to be traumatic in origin. The postoperative course was uneventful. We reviewed a rare case of pathologically proven traumatic solitary pulmonary hematoma. The rarity of this case is enhanced because the hematoma initially appeared to be a posterior mediastinal tumor.

Objective We sought to introduce a localization procedure (methylene blue-stained N-butyl cyanoacrylate and N-octyl cyanoacrylate glue) in localizing pulmonary small nodules and ground-glass opacities before thoracoscopic resection, and to evaluate its efficacy. Methods A total of 20 patients with pulmonary small nodules and/or ground-glass opacities, who underwent video-assisted thoracoscopic surgery from August 1, 2017 to March 1 2018, were included in the study. Results A total of 24 lesions in 20 patients underwent blue-stained glue localization. The success rate of localization was 100%, with a mean dose of 0.04±0.01 mL blue dye and 1 mL glue used for each lesion. The average time for the whole localization procedure was 15.4±6.3 minutes. All lesions were intraoperatively localized by visual inspection in combination with palpation. The complications related to the localization procedure included mild pneumothorax occurring in 9 patients and minor pulmonary hematoma in 4 patients. No pain or distress was reported. Conclusions Blue-stained glue injection is technically feasible and safe to localize pulmonary small nodules and ground-glass opacities before thoracoscopic resection.

Resumen La enfermedad causada por SARS-CoV-2 (Covid-19) se ha convertido en una pandemia mundial y en consecuencia en un problema de salud publica. Se han descrito multiples complicaciones asociadas a la COVID-19, entre ellas alteraciones de la coagulacion. Si bien es conocido que la infeccion induce un estado protrombotico, tambien se han descrito complicaciones hemorragicas en estos pacientes, sobre todo en pacientes anticoagulados. Presentamos dos casos de hematoma pulmonar espontaneo en pacientes con neumonia COVID-19 y terapia anticoagulante. Nuestro objetivo es describir esta complicacion, que, aunque poco frecuente, conviene tener en cuenta en pacientes anticoagulados y con COVID-19 concomitante.

Hemothorax (HT) and pulmonary hematoma represent rare complications of anticoagulant therapy. We present a rare case of a 53-year-old man with COVID-19 pneumonia who showed, in a follow-up computed tomography (CT) scan 13 days after hospitalization, a left HT and a small hyperdense area in a subpleural location and compatible with a small subpleural hematoma. This patient was being treated with a subcutaneous administration of low-molecular-weight heparin (100UI/kg/BID). No vascular malformations were visualized on the CT pulmonary angiography. Herein, we report the first case of both a spontaneous HT and a lung subpleural hematoma in a COVID-19 patient, probably caused by anticoagulant therapy.

Traumatic pulmonary giant hematoma, resulting from blunt trauma, is a relatively rare event. Here, we report the rare case of a patient with a giant traumatic pulmonary hematoma that was associated with blunt trauma. A 50-year-old man was admitted to our medical center after a fall from a height of 5 m. He was diagnosed with pulmonary contusion, and tests showed a huge pulmonary hematoma of approximately 8.2 × 5.3 × 13.2 cm in the left lung field along with other significant injuries. Treatment comprised of aggressive coagulation management, broad-spectrum antibiotics, and pulmonary hygiene. The patient's symptoms gradually improved and magnetic resonance scan revealed that he did not develop an abscess formation. No complications were seen at the 6 months follow-up visit. If the above mentioned measures would have failed to control the bleeding or secondary infection, then emergency surgery would have been warranted. Awareness of this kind of injury and efforts to reduce infection are important to guide the giant traumatic pulmonary hematoma to the benign course.

Background Pulmonary hematoma is most often caused by thoracic trauma. However, rare cases of pulmonary hematoma without any obvious cause are sometimes reported, when the condition is referred to as spontaneous or idiopathic pulmonary hematoma. Herein, we report a very rare case—to the best of our knowledge, this is the first case of pulmonary hematoma associated with diffuse pulmonary ossification requiring emergency treatment reported in the English literature. Case presentation Our patient was a 44-year-old man with a history of IgA nephropathy and had no history of trauma or anticoagulant use. He presented with the chief complaint of bloody sputum and was referred to our hospital for detailed examination. Chest computed tomography showed a right pleural effusion and a large round mass in the right lower lobe. We performed chest tube drainage of the right thorax and confirmed bloody pleural effusion. Although bronchial artery embolization was performed, the patient’s anemia worsened, and we performed right lower lobectomy. Histopathological examination of the resected specimen showed a hematoma with diffuse pulmonary ossification, although the relationship between the two was unclear. There was no evidence of malignancy or angiitis. Therefore, we made the diagnosis of spontaneous pulmonary hematoma in this case. The postoperative course was uneventful. The patient is currently under observation as an outpatient, and a recent chest X-ray showed no evidence of recurrence. Conclusion We report a case of spontaneous pulmonary hematoma with diffuse pulmonary ossification. Although the relationship between the two remains unclear, considering the possibility of appearance of new lesions/recurrence, we believe that careful follow-up is necessary for this patient.

Background: The majority of patients with severe blunt chest trauma is successfully treated with supportive measures and thoracostomy tube; only few cases need urgent thoracotomy. Lung-sparing techniques are treatments of choice but major pulmonary resections are necessary in case of injuries involving hilar vessels or bronchi. Currently the mortality associated with pulmonary lobectomy performed for chest trauma is 40%. Methods: Over a 2-year period [2013–2014], 210 patients with chest trauma were hospitalized at our Institution. Mechanism of injury was blunt in 204 (97.1%) patients and penetrating in 6 (2.9%). In 48 (22.8%) patients was necessary a ventilatory support and 37 (17.6%) patients were treated with thoracostomy tube. Nineteen (9%) patients needed urgent thoracotomy: 4 (1.9%) cases for penetrating injury and 15 (7.1%) cases for blunt trauma. Three (1.4%) patients treated with urgent thoracotomy required concomitant laparotomy for intra-abdominal injuries. The overall mortality rate was 1.4%. Results: We report three cases of urgent lobectomies for chest trauma without mortality and with postoperative complete restoration of respiratory function. The anatomical lobectomies were performed for: massive hemothorax with bronchial disruption, expanding pulmonary hematoma with hypovolemic shock, and massive hemothorax in deep parenchymal laceration. Conclusions: Mortality rate after major pulmonary resections for trauma is very high and increases with the presence of multivisceral injuries, the severity of hypovolemic shock and extent of lung resection. Anterolateral thoracotomy was the approach employed in case of cardiac arrest. In hypovolemic patients a posterolateral incision with a double lumen intubation was performed. The absence of mortality in this series may be related to the prompt diagnosis, short operative time and absence of associated severe neurological or abdominal injuries.

A 72-year-old patient was admitted to the medical intensive care unit due to a right-sided, hospital-acquired pneumonia and septic shock with respiratory failure and deterioration of chronic renal failure. During hospitalization the patient required hemodynamic support with norepinephrine and dobutamine, mechanical ventilation and hemodialysis. The patient suffered a non-ST segment elevation myocardial infarction (NSTEMI) and received dual antiplatelet therapy. After 14 days an acute intrapulmonary infiltrate of unknown origin developed, accompanied by fever and a significant increase of the C‑reactive protein (CRP) level. Chest radiography and a computed tomography (CT) scan showed a well-defined, round, high-attenuation lesion in the lungs and a suspected infected pulmonary hematoma, which was confirmed by percutaneous aspiration biopsy. There was no evidence of trauma and it is believed that the hematoma occurred spontaneously, probably because of the dual antiplatelet therapy. Double antibiotic treatment was started but no surgery was performed after consultation with a thoracic surgeon. The antiplatelet drugs were temporarily withdrawn until the size of the hematoma showed no further increase and then antiplatelet therapy was continued. After stabilization the patient was discharged from hospital and 6 months later a follow-up chest X‑ray showed almost complete resolution of the hematoma.

Background Pleomorphic adenomas, also known as benign mixed tumors, are the most common tumors of glandular origin in the head and neck and although they are generally benign they can undergo malignant transformation. Primary pleomorphic adenomas of the lung are extremely rare tumors with less than 40 cases reported in the literature by now. This is the first case in the literature describing overlapping with a traumatic event and also one of the rare cases describing primary adenoma of the lung reaching this impressive size. Case presentation We report a rare case of a giant primary pleomorphic adenoma of the lung presenting as a post-traumatic pulmonary hematoma. A 38-year-old Caucasian male patient came to the Urgent Trauma Center after being hit in the chest by a bull and, after a number of tests, was diagnosed with primary pleomorphic adenoma of the lung. Operative treatment was performed and the surgical excision was successfully done. Conclusions Our conclusion is that the surgical excision is the main treatment for pleomorphic adenoma of the lungs and we recommend lifelong follow-up and regular check-ups. Furthermore, we consider our case an interesting one due to its concurrence with the chest trauma and the dilemma about the optimal approach considering the entity could have been a large interlobular hematoma.

Thoracic aortic aneurysm can rupture into adjacent structures, such as pericardial and pleural cavities, trachea and bronchi, esophagus, but rupture into the lung parenchyma is rare. Clinic presentations largely depend on the site of rupture, frequently presenting as sudden death; however, an immediate rupture into the lung, accompanied by fatal hemoptysis and aspiration, is very rarely encountered [1]. CT should be considered the prefered diagnostic technique for the ruptured aneurysm into the lung. Disseminated alveolar hemorrhage and pulmonary hematoma are easily detected by CT scan, as described in our case. Evaluation of the aorta with CT angiography allows confirmation of the aneurysm as well as defining the extent of the diameter.

We present chest radiograph, CT and MRI findings in a case of pulmonary hematoma associated with anticoagulant therapy. The lesion presents as a well-defined mass in the right lower lobe; shows high density on unenhanced CT. At MRI performed 50 days after the first consultation, the nodule is hyperintense in T2-weighted MRI images and hypointense with a hyperintense peripheral rim in T1-weighted images.

Severe intrathoracic hemorrhage from pulmonary parenchyma is the most serious complication of pulmonary laceration after blunt trauma requiring immediate surgical hemostasis through open thoracotomy. The safety and efficacy of video-assisted thoracoscopic surgery (VATS) techniques for this life-threatening condition have not been fully evaluated yet. We report a case of pulmonary laceration with a massive hemothorax after blunt trauma successfully treated using a combination of muscle-sparing minithoracotomy with VATS techniques (video-assisted minithoracotomy). A 22-year-old man was transferred to our department after a falling accident. A diagnosis of right-sided pneumothorax was made on physical examination and urgent chest decompression was performed with a tube thoracostomy. Chest computed tomographic scan revealed pulmonary laceration with hematoma in the right lung. The pulmonary hematoma extending along segmental pulmonary artery in the helium of the middle lobe ruptured suddenly into the thoracic cavity, resulting in hemorrhagic shock on the fourth day after admission. Emergency right middle lobectomy was performed through video-assisted minithoracotomy. We used two cotton dissectors as a chopstick for achieving compression hemostasis during surgery. The patient recovered satisfactorily. Video-assisted minithoracotomy can be an alternative approach for the treatment of pulmonary lacerations with a massive hemothorax in hemodynamically unstable patients.

A 65-year old man presented at the emergency department with acute shortness of breath, chest pain, cough and haemoptysis. The patient is an ex-smoker with a total of 35 pack years and an extensive medical history, including a serious traffic accident with neurotrauma, chronic obstructive pulmonary disease, degenerative spine and hip disease, ethylism, a type A aortic dissection and atrial fibrillation. His medication list is extensive and includes a bronchodilator, an antiepileptic, several antihypertensive drugs, pain medication, amiodarone, acetylsalicyc acid and subcutaneous low molecular weight heparin. Chest X-ray showed a rounded opacity in the mediobasal segment of the right lower lobe that could not be seen on previous radiographs (Fig. A). Biochemistry demonstrated an elevated CRP (48 mg/L) and elevated D-dimers (2190 ng/ml). CT thorax was performed to rule out pulmonary embolism. CT thorax showed a sharply demarcated relatively hyperdense mass (mean density on pulmonary artery phase images of 46 HU) with a maximum diameter of 5,5 cm in the mediobasal segment of the right lower lobe abutting the distal vena cava superior (Fig. B). An endobronchial ultrasounded (EBUS) guided biopsy of the lesion was performed. Pathologic examination showed pulmonary tissue with signs of hemorhage and fibrotic changes. No signs of malignancy were seen. An old thorax CT made in another hospital revealed that the location of the mass corresponded exactly with the location of a large bulla (Fig. C). Based on this new information the diagnosis of pulmonary hematoma within a bulla was made.

A 20-year-old male is presented with hemoptysis since 3 months. Plain chest X-ray and computed tomography (CT) chest at that time showed bilateral hilar shadows. Recent X-ray showed a huge right-sided well-defined opacity. CT chest and magnetic resonance angiography were ordered for him revealing a huge intrapulmonary hematoma.

A 76 year-old man with COPD was addmited to our coronary care unit because of ST elevation myocrdial infarction. It was diagnosed by a combination of typical history, clinical features and electrocardiographic changes (ishemic lesion of the inferoposterior wall of the left ventricul) [1]. On addmision cardiac biochemical markers were within normal limits. There were no relative or absolute contraindications for thromolytic therapy [2]. Intravenous therapy with streptokinase, 1.5 million IU over 60 minutes was administered, followed by low molecular weight heparin and aspirin. Chest pain resolved and ECG showed regression of ST segment elevation, with frequent ventricular premature beats ; cardiac markers peaked 8 hours after streptokinase administration. Forty-eight hours after streptokinase administration hemoptysis occured, next day followed by profuse hemoptoa with significant decrease in blood pressure (85/40 mmHg), tachycardia (120/min) and rise of body temperature to 38.2 º ; C. Control blood count showed decrease of hemoglobin level from initial 122 to 87 g/L, hematocrit from initial 0.36 to 0.20. A control chest radiogram showed a large localized region of opacification (9x7 cm) in the upper right lung lobe, suggesting pulmonary hematoma. Anticoagulant and antiplatel therapy was discontinued and correction of consequent anemia with transfusion of erythrocyts was carried out. Further diagnostic studies such as control chest radiogram, bronchoscopy, bronchoalveolar lavage (BAL), Ziehl-Nielsen stainig, Lowenstein sputum cultures and chest CT, excluded bronchopneumonia, malignancy, bronchiectatic disease, active pulmonary tuberculosis and confirmed pulmonary hematoma. On the second day hemoptoa stopped. The patient was discharged and in stable condition on follow-up. A control chest radiogram six months later showed coplete resolution of hematoma.

Background: A wide variety of diseases in children can present with peripheral lung lesions. Minimally invasive percutaneous techniques are preferred diagnostic tools when thoracoscopic resection is not indicated. Significant improvements in US resolution have increased the range of its applications for many diagnostic and therapeutic purposes. Objective: To determine the adequacy and safety of US-guided biopsy of peripheral pulmonary lesions in children. Materials and methods: A retrospective review was performed of the clinical, imaging and pathology records of 33 children (13 females and 20 males) in whom 38 US-guided percutaneous lung lesion biopsies had been performed between January 1996 and March 2004. Their mean age was 8.3 years (range 1–19 years, median 6.6 years). All procedures were done under general anesthesia and controlled respiration. Two techniques were used: a single-needle technique and a coaxial-needle technique. In each case, the data recorded included age, sex, lesion’s location and size, number of cores, pathology results (adequate, inadequate and indeterminate), and complications. In order to categorize the sample, the lesions were divided into four groups based on the size of the pleural surface: group 1 1–5 mm, group 2 6–10 mm, group 3 11–20 mm, and group 4 21 mm or more. Results: The mean pleural surface size of the lesions was 12 mm (range 2.3–24 mm). The coaxial-needle technique was used for 13 biopsies and the single-needle technique for 25 biopsies. Of the 38 biopsies, 32 were considered adequate (technical success 84%), 4 were truly inadequate, and 2 were indeterminate at the time of the biopsy, requiring surgical biopsy for confirmation. Minor complications occurred following 44% of the procedures, including: pain (n=5), small pneumothorax (n=4), pulmonary hematoma (n=4), atelectasis (n=4), small hemothorax (n=3), respiratory distress (n=1) and hemoptysis (n=1). No major complications occurred. No significant correlation was found between the size of the pleural surface and technical success (P=0.106) or the incidence of complications (P=0.23). Minor complications occurred following 6 out of 13 procedures using the coaxial-needle technique (16% of total) and following 11 out of 25 procedures using the single-needle technique (28% of total), with no statistically significant difference (P=0.1081). Conclusion: This small retrospective study suggests that US-guided lung biopsies are a safe and adequate method to sample peripheral pulmonary lesions in children, with a high rate of technical success and low morbidity, even for lesions with a small pleural surface (

A 57-year-old male patient was admitted to our center because of a cystic mass on the lower portion of the right major fissure that was found incidentally by chest X-ray. He did not have a history of trauma or anticoagulant use. The lesion was removed by video-assisted thoracoscopic surgery. Pathological examination revealed an organizing pulmonary hematoma without any complications, and a follow-up chest X-ray after 1 year showed no recurrence.

The chest x-ray of a 47-year-old man showed a large density in the left lung and malignancy was suspected. Tc-99m MIBI lung imaging showed a photopenic area in the lower two thirds of the left lung. Lung perfusion scintigraphy with Tc-99m MAA performed before MIBI lung imaging showed a large perfusion defect in the lower two thirds of the left lung. CT showed a large cystic area in the left lung, bronchoscopy and bronchography showed displacement of the left sided bronchioles by the enormous cystic formation. Surgery showed organized intrapleural and pulmonary hematomas possibly caused by a prior thoracic injury or spontaneous rupture of an emphysematous bleb.

We report a case of circumscribed intrapulmonary hematoma, in which MR findings were useful in establishing the diagnosis. It is usually easy to make a diagnosis of intrapulmonary hematoma using conventional methods, when clinical history of trauma and regression of the mass can be observed on serial radiography. However, in this case the mass remained almost unchanged 4 months after trauma on chest radiography and CT. Magnetic resonance revealed a hyperintense mass with an even higher signal rim on T1-weighted imaging and an irregular hyperintense mass on T2*-weighted imaging. We made a diagnosis of pulmonary hematoma based on these MR findings. Follow-up chest radiography and CT taken 1 year after the injury, revealed a substantial decrease in the size of the mass, which confirmed the diagnosis. As in this case, some intrapulmonary hematomas regress very slowly or may even increase in size, and diagnosis can be difficult with conventional methods. In such cases, MRI can be helpful.

The vascular type of Ehlers-Danlos syndrome (vEDS) is the most severe form of Ehlers-Danlos syndrome. Patients with vEDS show deficiency or abnormality in type III collagen responsible for production of vascular structures. The disease causes organs to become fragile and vulnerable to rupture, which may lead to sudden death. The diagnosis of vEDS is often delayed until a catastrophic complication occurs or is discovered in postmortem examination. Here we report an unusual case of an isolated pulmonary hematoma mimicking a lung tumor in an 18-year-old man which turned out to be the initial finding of vEDS.

Abstract 4107 Objectives To determine the pulmonary pathological changes in patients of hematological malignancies with pulmonary complications using surgical or thoracoscopic technologie. Methods 17 hematological malignant patients who underwent surgical treatment were evaluated retrospectively in our study. Pulmonary infection was presented in 14 cases following chemotherapy, and lesions can not be completely absorbed after a broad-spectrum anti-bacterial and anti-fungal treatment. Furthermore, computerized tomographic scanning showed that there remained several kinds of localized lesions. Subsequently, all the 17 patients underwent open lung or thoracoscopic biopsies (lobar, partial, or wedge resection). The pathological changes of all the surgical specimens were examined postoperatively by standard hematoxylin and eosin staining. Results Pathological examination confirmed: Aspergillus infection in 9 patients, sub-acute inflammation (fibrosis and hematoma formation) in 3 patients, pulmonary infarction with granulomatous tissue in the periphery in 1 patient, granulomatous inflammation with calcified tubercle in 1 patient, alveolar dilation and hemorrhage, interstitial fibrosis and focal vasculitis in 1 patient, intercostal neurilemmoma in 1 patient, and moderate-differentiated adenocarcinoma accompanied by intrapulmonary metastasis in 1 patient. And several operative complications (1 case of fungal implantation, 3 cases of pleural effusion and adhesions and 2 cases of pulmonary hematoma) were occurred. The coincidence rate of pre- and post-operative diagnosis was 9/14 (64.3%). After surgery, 8 patients were received hematopoietic stem cell transplantation (HSCT, allo-gene or autologous), in which 7 cases were succeeded. Following the effective secondary antifungal prophylaxis,4 of 5 patients of aspergillosis were succeeded in transplantation free from mycotic relapse,just one patient was dead from fungal relapse. Conclusion Hematological malignancies with certain pulmonary complications, that is, persistent and/or medical-management-resistant pulmonary infection, hemoptysis, or lung diseases of diagnosis unknown, should be treated in time by surgical resection to effectively eliminate the residual disease and to achieve definitive diagnosis, so as to create a prerequisite condition for the following treatments. Moreover, the secondary antifungal prophylaxis could provide positive roles in protecting patients scheduled for chemotherapy and/or HSCT. Keywords hematological malignancies; immunocompromise; pulmonary aspergillosis; pulmonary resection; histopathology ; secondary antifungal prophylaxis Disclosures: No relevant conflicts of interest to declare.

The pathophysiology of pulmonary hematoma is discussed. The presence of the air-crescent sign in a coin lesion is nonspecific; however, it may direct the attention of the physician to consider a traumatic etiology.

Pulmonary contusion, implying interstitial and alveolar injury without significant laceration, has been accepted as the primary lung injury in nonpenetrating chest trauma. Computed tomographic (CT) findings were compared with those of chest radiography in 85 consecutive patients with chest trauma in which there was a pulmonary radiodensity consistent with pulmonary contusion or patients with a history of severe chest trauma with normal parenchyma despite rib fractures, hemothorax, pneumothorax, or widened mediastinum. CT was found to be more sensitive than radiography in that 151 abnormalities (excluding rib fractures) were demonstrated on radiographs versus 423 abnormalities on CT scans, and 99 lacerations were seen on CT scans versus five on radiographs. Pulmonary lacerations were classified into four types on the basis of CT findings and mechanism of injury: compression rupture, compression shear, rib penetration, and adhesion tears. In these cases, pulmonary laceration was shown to be an integral component of the mechanism of injury in pulmonary contusion, pulmonary hematoma, pulmonary cyst or pneumatocele, or cavitation in pulmonary contusion.

Traumatic pulmonary and paramediastinal pneumatoceles are definite, acutely formed, primary structural manifestations incident to nonpenetrating chest trauma. They are not secondary lesions, i.e., cavities or pneumatoceles resulting from the resolution of a pulmonary hematoma. Awareness of this fact will explain the not uncommon finding of a cavitary lesion, often containing an air-fluid level, on initial emergency room radiographs of patients who have sustained closed chest trauma. This will avoid unnecessary and unpleasant diagnostic procedures, including thoracotomy, for traumatic pneumatoceles are self-limiting, benign abnormalities which usually require no therapy other than observation.

A 70-year-old man with severe thrombocytopenia was found to have a “coin lesion” in the left lung four days after splenectomy for localized reticulum cell sarcoma. Bronchoscopy, sputum cytology, and chest roentgenograms over the subsequent six weeks were noncontributory. Since the appearance of the lesion remained unchanged, exploratory thoracotomy was performed. An organizing pulmonary hematoma was found and removed by segmental resection of the lung. In the absence of a history of trauma to the chest, bleeding from the pulmonary vessels incident to the thrombocytopenia associated with the splenic tumor was considered responsible for the hematoma.

Pulmonary contusion and pulmonary hematoma are observed frequently in patients who sustain closed chest injuries. A lesion seen less often in these circumstances is localized disruption of the lung parenchyma that produces cystlike cavities. This should not be confused with extensive disruption of the pulmonary parenchyma, usually accompanied by extensive bleeding and shock. A review of the literature and three case reports are presented as well as a discussion of the pertinent symptoms and the clinical and radiological findings. The different nomenclatures used to define these lesions are reviewed briefly.