CTICasesSpontaneous Hemothorax due to Ruptured Bulla
Imaging findings
Chest CT angiogram reveals a very large, high-attenuation pleural fluid collection occupying the right hemithorax, with dependent layering of hyperdense material and free gas, consistent with a hemopneumothorax. No history of trauma or medical intervention is present. Lung windows show apical subpleural bullae with apical pleural scarring, but no parenchymal laceration.
Key takeaways
Spontaneous hemothorax is a rare but potentially life-threatening complication of a ruptured apical bulla. The bleeding is believed to result from the tearing of vascularized adhesions between the lung apex and the parietal pleura as the lung collapses rapidly following bulla rupture.
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