Spontaneous hemothorax during general anesthesia

We report a case of spontaneous hemothorax in a healthy 27-year-old man undergoing elective reconstruction of the right anterior cruciate ligament (ACL) under general anesthesia. In the postanesthesia care unit (PACU), the patient became hypotensive and tachycardic with mid-sternal chest discomfort. A chest roentgenogram revealed an almost complete opacification of the right hemithorax. A diagnostic thoracentesis was positive for frank blood, confirming a right hemothorax. The patient was emergently taken back to the operating room. A chest tube was inserted, and 3.3 l of dark blood was drained. Once the patient improved hemodynamically, we proceeded with a right video-assisted thoracoscopic surgery (VATS). A bleeding vessel incorporated in a bleb was identified at the apex of the right lung. The bleeding vessel was clipped. A wedge resection of the apical bleb was performed and the associated torn vascular adhesion was stapled. The patient was found to have bullous disease at the apical region of the right lung. These bullae can undergo neovascularization and form vascularized bullae. Rupture of these vascularized bullae can cause a spontaneous hemopneumothorax. In our patient it is possible that an apical vascularized bulla ruptured causing a massive intrapleural bleed.