Initial imaging revealed a lesion posterior to the thecal sac from T5 to T8 with a fluid–fluid level and causing compression of the spinal cord. Immediate laminectomy was carried out and bright red blood mixed with clot gushed out on opening of the lamina. The haematoma was completely excised and sent for histology. Metastatic carcinoma was reported and the patient underwent a CT scan which showed a left hilar lung mass. Bronchial washings revealed adenocarcinoma. Their literature search revealed no other such cases and they were unclear as to the source of blood causing this haematoma. They postulated the bleeding may have resulted from the tumour itself or from epidural venous plexuses

that were more friable due Trametinib mw to the tumour itself and surrounding inflammation. Chou et al., in 1993 [2] described what was thought to be the first case report of a spontaneous haemothorax resulting from a sub-pleural lung mass. Histology of a resected sample revealed a small perforation in the visceral pleura with tumour invasion into the pulmonary vessels and visceral pleura. In 1980, Miller and McGreggor [11] carried out a review to evaluate haemorrage in different types of lung cancer. They found that massive haemoptysis was likely to be related to squamous cell carcinoma (SCC) and this

in turn may be linked to the fact that SCC is the most likely type of tumour to be cavitating and that this process of cavitation was caused by necrosis resulting from vascular invasion by malignant cells and this in turn results in haemorrhage. The exact reasons for the mode of this biphasic presentation Epigenetic signaling pathway inhibitor seen here in this report are unclear. It is possible that the initial presentation with a febrile illness one year prior to the patient’s death was due to infection within a benign lung cyst, cystadenoma or a lung abscess and that subsequent malignant transformation resulted in metastatic cancer. It is likely that the source of the blood in each lesion was from malignant invasion of blood vessels

which also resulted in haematogenous spread of the tumour to various distant metastatic Etomidate sites. This case report, in our view, represents the first published case of metastatic multicyctic haemorrhagic adenocarcinoma of the lung involving 3 organs (lung, adrenal and brain). Prior to writing this article consent for publication of this case was obtained from the patient’s next of kin. None. We would like to thank Dr Nicholas Reading and Dr Konstantinos Giaslakiotis for their contribution to the figures included in this article. “
“Thoracic splenosis (TS) is a rare condition resulting from autotransplantation of splenic tissue into the chest after thoracoabdominal trauma with spleen and diaphragm injuries [1]. Generally, patients are asymptomatic and diagnosis is given incidentally [2] and [3].