Spontaneous hemopneumothorax: an overlooked life-threatening condition.

Spontaneous hemopneumothorax is a rare clinical entity. A large spontaneous hemopneumothorax is life-threatening, and mortality increases with delayed recognition and intervention. The initial chest radiography and the amount of blood drained from the inserted chest tube frequently underestimates the actual blood loss from the active bleeder around the ruptured apical bullae, leading to failed recognition of a potentially life-threatening condition until unexpected hemodynamic collapse develops.