[Nine cases of spontaneous hemopneumothorax with massive bleeding]

We experienced nine cases of spontaneous hemopneumothorax. All the patients were male and six of those had received emergent operations because of massive intrathoracic bleeding. In six of the nine cases we found the bleeding from the ruptured string like tissues between parietal pleura and the apex of the upper lobe. Those string like tissues contained vessels and were suspected to have ruptured when the lung collapsed. In other three cases the bleeding was controlled conservatively but operations were performed because of continuous air leakage and the bleeding were found from the bullous apical tissues of the lung adhered to the thoracic wall. Histopathologically those bullous tissues and string like tissues were revealed grannuromatous and chronic pleuritis rich in microvessels. Early thoracotomy for spontaneous hemopneumothorax was recommended in case of massive intrathoracic bleeding.