Bilateral pneumothorax is very rare in primary spontaneous pneumothorax patients. This condition can cause chest pain, dyspnea, and even lead to tension pneumothorax. Spontaneous hemopneumothorax can be lethal due to massive bleeding and hypovolemic shock. This condition requires precise decision making and emergency management. We report on a case of simultaneous bilateral spontaneous pneumothorax combined with hemopneumothorax in a healthy 21-year-old male patient with chest discomfort. In the emergency department, closed thoracostomy was performed for decompression of hemopneumothorax, with drainage of 850 mL of blood. Then bilateral video-assisted thoracoscopic surgery was performed successfully.
Chest Pain ; Decision Making ; Decompression ; Drainage ; Dyspnea ; Emergencies ; Emergency Service, Hospital ; Hemopneumothorax* ; Hemorrhage ; Humans ; Male ; Pneumothorax* ; Shock ; Thoracic Surgery, Video-Assisted ; Thoracostomy ; Thorax ; Young Adult

Tendon and ligament (T/L) have been known to be obviously different from each other in tissue level. However, due to the overlapping gene markers, distinction in cellular level has not been clearly verified yet. Recently, the use of nuclear magnetic resonance (NMR) spectroscopy has shown the potential to detect biological markers in cellular level. Therefore, in this study we applied a non-invasive technique based on NMR spectroscopy to establish biomarkers to distinguish between T/L fibroblasts. In addition the cellular morphologies and gene expression patterns were also investigated for comparison through optical microscopy and real-time polymerase chain reaction (PCR). No difference was observed from morphology and real-time PCR results, either as expected. However, we found clear differences in their metabolomic spectra using ¹H NMR spectroscopy. The calculated integral values of fatty acids (with chemical shifts at ~0.9, 1.26, 1.59, 2.05, 2.25, and 2.81 ppm), lactate (~1.33 ppm), and leucine (~2.72 ppm) were significantly different between the two types of fibroblasts. To be specific tendon group exhibited higher level of the metabolite than ligament group. In conclusion, in-cell metabolomic evaluation by NMR technique used in this study is believed to provide a promising tool in distinguishing cell types, especially T/L cells, which cannot be classified by conventional biological assays.
Biological Assay ; Biomarkers ; Fatty Acids ; Fibroblasts* ; Gene Expression ; Genes, Overlapping ; Lactic Acid ; Leucine ; Ligaments* ; Magnetic Resonance Spectroscopy* ; Metabolomics ; Microscopy ; Real-Time Polymerase Chain Reaction ; Spectrum Analysis* ; Tendons*