Hemopneumothorax After Carotid Endarterectomy

Spontaneous hemopneumothorax (SHP) is a rare condition characterized by the accumulation of air and blood in the pleural cavity without prior trauma. We present a case of a patient who underwent carotid endarterectomy for carotid artery stenosis. Two days postoperatively, she developed sudden respiratory distress, hypotension, tachycardia, and a decrease in hemoglobin levels. A chest X-ray revealed a massive left-sided hemopneumothorax. A chest tube was inserted, but no active bleeding source was identified on subsequent imaging. Despite initial stabilization, the patient required intubation and underwent video-assisted thoracoscopic surgery for residual hemothorax and empyema. She fully recovered. In this case report, we provide an overview of the diagnostic and treatment options for SHP. As SHP is a potentially life-threatening condition, we emphasize the importance of including it in the differential diagnosis of sudden patient deterioration. In our case, the patient had undergone vascular surgery; however, the cause of hemorrhagic shock was unexpectedly SHP.