Chest
Volume 57, Issue 5, May 1970, Pages 487-489
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Selected Reports
Pulmonary Hematoma Associated with Thrombocytopenia

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A 70-year-old man with severe thrombocytopenia was found to have a “coin lesion” in the left lung four days after splenectomy for localized reticulum cell sarcoma. Bronchoscopy, sputum cytology, and chest roentgenograms over the subsequent six weeks were noncontributory. Since the appearance of the lesion remained unchanged, exploratory thoracotomy was performed. An organizing pulmonary hematoma was found and removed by segmental resection of the lung. In the absence of a history of trauma to the chest, bleeding from the pulmonary vessels incident to the thrombocytopenia associated with the splenic tumor was considered responsible for the hematoma.

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CASE REPORT

A 70-year-old white man first entered the M. D. Anderson Hospital in February, 1967, because of evidence of thrombocytopenic purpura. He exhibited signs of chronic illness, including moderate pallor, and petechiae were present over his entire trunk and lower extremities. He gave no history of exposure to toxic substances or drugs. Upon admission to the hospital, his hemoglobin was 10 gm percent, and his platelet count was 12,000 mm3. The following day, however, the platelet count fell to 1000 mm

COMMENT

According to previously published reports, the vast majority of patients with traumatically induced pulmonary hematomas are children or young adults. Specht1 found that 85 percent of these patients were less than 30 years old. Only two patients were more than 60 years of age. Our patient was 70 years old.

Reportedly, also, the injury is followed by minor to moderate pain localized to the site of the trauma and may persist for several days. Dyspnea, beginning soon after the injury, is also

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