Cardiopulmonary Resuscitation Leads to Hemothorax from an Unlikely Source: A Case Report

Document Type

Conference Proceeding - Restricted Access

Publication Date

5-8-2026

Abstract

Cardiopulmonary resuscitation (CPR) is a life-saving intervention in cardiac arrest, but is frequently associated with thoracic trauma from chest compressions. Hemothorax, the accumulation of blood within the pleural space, is an uncommon complication, accounting for approximately 5-24% of CPR-associated intrathoracic injuries. Bleeding typically occurs from intrathoracic vessel damage, such as ruptures to the azygous vein or intercostal arteries. Few cases like ours are documented, demonstrating a substantial hemothorax due to post-CPR pulmonary artery branch hemorrhage, highlighting the diagnostic reasoning required to identify atypical bleeding sources and the role of interventional radiology in management.

A 77-year-old man with COPD, paroxysmal atrial fibrillation/flutter, dialysis-dependent chronic kidney disease, and recent cardiothoracic surgery for infective endocarditis was transferred to the ICU for septic shock and acute on chronic respiratory failure. His course was complicated by prolonged ventilator dependence, recurrent MRSA ventilator-associated pneumonia, and intolerance of intermittent hemodialysis. One week later, he developed sudden hypotension and two instances of cardiac arrest with return of spontaneous circulation after brief CPR and epinephrine. Post-arrest evaluation revealed severe mixed acidosis, bloody airway secretions, and an acute hemoglobin drop to 5.5 g/dL. Bronchoscopy demonstrated bilateral bronchomalacia with diffuse bloody secretions. CT of the thorax demonstrated a large right hemothorax with active intrapleural contrast extravasation, prompting angiographic evaluation for suspected intrathoracic hemorrhage.

This case highlights a rare cause of massive hemothorax resulting from a pulmonary artery branch CPR-associated injury, leading to recurrent cardiac arrest and hemorrhagic shock. It demonstrates the importance of promptly identifying nontraditional bleeding sources and coordinating multidisciplinary management in critically ill patients with complex cardiopulmonary comorbidities.

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 2142

This document is currently not available here.

Share

COinS