Primary Spontaneous Hemothorax secondary to Lung Adenocarcinoma

Spontaneous haemothorax is a clinical entity encompassing non traumatic accumulation of blood within the pleural space. Although hemothorax is often encountered in clinical practice, spontaneous hemothorax is an infrequent occurrence. Cases of spontaneous hemothorax have known to occur secondary to coagulopathy, malignancy, av malformations, pulmonary infarction and tuberculosis. The neoplasms known to be associated with hemothorax include schwannomas, Hepatocellular carcinoma and soft tissue tumors. lung carcinoma is a rare cause of hemothorax even in the setting of pleural extension. Here we highlight the importance of diagnosis spontaneous hemothorax in case of a primary lung malignancy. A 75 year old woman with no significant past medical history, who presented to the ED with chest pain, was initially diagnosed with a pulmonary embolism. As a part of the work up for cause of pulmonary emboli in this otherwise healthy woman, a CT chest performed revealed an incidentally found right hilar lung mass and she was scheduled for an outpatient workup. A month later, she developed shortness of breath and presented to the ED before her scheduled appointment. A large pleural effusion was seen on the repeat CT chest. She underwent thoracocentesis, with pleural studies consistent with hemothorax. Eventually, she underwent endobronchial ultrasound with biopsy of lung mass. Based on the histopathology findings, she was diagnosed with adenocarcinoma. We concluded that she likely experienced spontaneous hemothorax secondary to lung adenocarcinoma. To our knowledge there have been three other case reports of spontaneous hemothorax secondary to bronchogenic carcinoma. Cases of hepatocellular carcinoma with hemothorax have been known to have poor prognosis. Being uncommon, the prognostic implication of spontaneous hemothorax in primary lung malignancies has not been studied. Recognition of hemothorax in these patients can alter the course of management