High-definition thoracoscopic visualization of the apical pleuropulmonary vascular bridge in spontaneous hemopneumothorax
- 1Department of Thoracic Surgery, University of Health Sciences, Antalya Training and Research Hospital, Antalya, Türkiye
Abstract
Introduction: Spontaneous hemopneumothorax (SHP) is an uncommon but life-threatening complication of spontaneous pneumothorax (SP). Apical vascular adhesions are recognized bleeding sources; however, the terminology used to designate them remains inconsistent. Aim: This study aimed to describe the thoracoscopic appearance and surgical management of apical vascular bridge bleeding in SHP. A term “apical pleuropulmonary vascular bridge” (APVB) is proposed for this anatomical structure. Materials and methods: We retrospectively reviewed patients treated for SHP between January 2020 and December 2024. SHP was defined as SP with bloody pleural drainage of at least 400 ml or pleural fluid hematocrit greater than 1%. Demographics, drainage volume, transfusion requirement, operative findings, surgical approach, and outcomes were analyzed. One index case with high-definition thoracoscopic video documentation was selected to demonstrate the bleeding pattern and surgical control. Results: A total of 12 patients at a mean (SD) age of 47.8 (18.3) years were included in the study; 11 (91.7%) were men. Median (interquartile range) initial drainage volume was 250 (175–500) ml (range, 50–1200 ml). Two patients (16.7%) required blood transfusion. Seven individuals (58.3%) underwent surgery: 3 video-assisted thoracic surgery (VATS) and 4 thoracotomy. In all surgically explored cases, the bleeding source was a thin-walled vascular structure extending from the apical parietal pleura to the visceral pleural surface of the upper lobe. Active arterial-type bleeding was observed in 6 patients. Hemostasis was achieved in all surgical cases, and no mortality occurred. Conclusions: The APVB may represent a useful descriptive term for this recognizable thoracoscopic bleeding source. Early surgical exploration, preferably via VATS when feasible, enables precise identification and definitive hemostasis.
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BibTeX
@article{karatas2026highdefinition,
title = {{High-definition thoracoscopic visualization of the apical pleuropulmonary vascular bridge in spontaneous hemopneumothorax}},
author = {Okan Karataş and Nilay Çavuşoğlu Yalçın and Muharrem Özkaya},
journal = {Videosurgery and Other Miniinvasive Techniques},
year = {2026},
month = oct,
doi = {10.20452/wiitm.2026.18041},
url = {https://doi.org/10.20452/wiitm.2026.18041},
note = {CC BY},
}
RIS
TY - JOUR
TI - High-definition thoracoscopic visualization of the apical pleuropulmonary vascular bridge in spontaneous hemopneumothorax
AU - Okan Karataş
AU - Nilay Çavuşoğlu Yalçın
AU - Muharrem Özkaya
PY - 2026
DA - 2026/10/01
JO - Videosurgery and Other Miniinvasive Techniques
DO - 10.20452/wiitm.2026.18041
UR - https://doi.org/10.20452/wiitm.2026.18041
AB - Introduction: Spontaneous hemopneumothorax (SHP) is an uncommon but life-threatening complication of spontaneous pneumothorax (SP). Apical vascular adhesions are recognized bleeding sources; however, the terminology used to designate them remains inconsistent. Aim: This study aimed to describe the thoracoscopic appearance and surgical management of apical vascular bridge bleeding in SHP. A term “apical pleuropulmonary vascular bridge” (APVB) is proposed for this anatomical structure. Materials and methods: We retrospectively reviewed patients treated for SHP between January 2020 and December 2024. SHP was defined as SP with bloody pleural drainage of at least 400 ml or pleural fluid hematocrit greater than 1%. Demographics, drainage volume, transfusion requirement, operative findings, surgical approach, and outcomes were analyzed. One index case with high-definition thoracoscopic video documentation was selected to demonstrate the bleeding pattern and surgical control. Results: A total of 12 patients at a mean (SD) age of 47.8 (18.3) years were included in the study; 11 (91.7%) were men. Median (interquartile range) initial drainage volume was 250 (175–500) ml (range, 50–1200 ml). Two patients (16.7%) required blood transfusion. Seven individuals (58.3%) underwent surgery: 3 video-assisted thoracic surgery (VATS) and 4 thoracotomy. In all surgically explored cases, the bleeding source was a thin-walled vascular structure extending from the apical parietal pleura to the visceral pleural surface of the upper lobe. Active arterial-type bleeding was observed in 6 patients. Hemostasis was achieved in all surgical cases, and no mortality occurred. Conclusions: The APVB may represent a useful descriptive term for this recognizable thoracoscopic bleeding source. Early surgical exploration, preferably via VATS when feasible, enables precise identification and definitive hemostasis.
SN - 1895-4588
SN - 2299-0054
ER -