Spontaneous Hemopneumothorax: An Uncommon Cause of Acute Hemodynamic Collapse

Spontaneous hemopneumothorax (SHP) is a rare but potentially life-threatening condition that may present with hemodynamic instability or even hypovolemic shock without an apparent cause. Given its nonspecific presentation, diagnosis is often overlooked or delayed. There are no standardized guidelines for SHP management, although the literature tends to favor early surgical intervention. Patients with hemodynamic instability, massive bleeding, persistent air leak, retained hemothorax, or trapped lung should undergo surgery. Minimally invasive surgery may be feasible in unstable patients who respond to fluid resuscitation. We report a case of a 21-year-old male patient who presented with sudden right-sided chest pain and unexplained hemodynamic instability. On admission, he was stable, and chest radiography showed a right pneumothorax with a moderate pleural effusion. A chest tube drained over two liters of blood. While awaiting a CT scan, the patient developed hypotension and tachycardia, prompting transfer to a tertiary hospital. Chest CT revealed active bleeding near the right subclavian artery. The patient underwent urgent video-assisted thoracic surgery (VATS), which demonstrated a moderate hemothorax and active bleeding from an apical adhesion likely disrupted by a spontaneous pneumothorax. Hemostasis was achieved, and the postoperative course was uneventful. SHP should be considered in young patients presenting with spontaneous pneumothorax and unexplained hemodynamic instability. Early diagnosis and prompt management are essential to prevent life-threatening hemorrhage and long-term complications. VATS represents a safe and effective surgical approach, even in unstable patients who respond to fluid replacement therapy.