Case Report: Spontaneous Hemothorax noted after Uncomplicated Cesarean Section

Introduction Few case reports exist of spontaneous hemothorax in pregnant patients. Those that do, describe unique cases where this finding is related to a primary pathology such as a bleeding hysterotomy, a ruptured ectopic pregnancy, or a pulmonary arterio-venous malformation. Other case reports have described spontaneous hemothorax in gynecological patients secondary to trauma, ruptured thoracic endometriomas, or diaphragmatic hernias in the presence of active abdominal bleeding. We describe the first case report of spontaneous hemothorax after an otherwise uncomplicated cesarean delivery. Case Report A 42-year-old gravida 16 para 2-2-12-4 underwent a scheduled repeat low transverse cesarean section at term which was uncomplicated with a quantitative blood loss of 536 milliliters. Postoperatively, patient had violent emesis followed by low blood pressures (80s/60s) without tachycardia and right sided chest pain. Ultrasound demonstrated minimal fluid in the abdomen with a negative exam; however, a Chest CT demonstrated a large right pleural effusion. Thoracentesis was performed, notable for drainage of 675 mL of dark bloody fluid. Post-thoracentesis, the patient noted improvement in her symptoms without re-accumulation of this fluid. Discussion Our case is unique as this hemothorax developed in an otherwise uncomplicated postpartum patient without a clear trigger. Our patient had risk factors that could have contributed to this spontaneous hemothorax, however, no etiology would necessarily be triggered by the postpartum state and final cause of this patient’s hemothorax is uncertain. OBGYN providers need to maintain a high index of suspicion for this rare complication even in routine cases.