& Aims: Spontaneous hemopneumothorax (SHP) is a rare condition that can result in shock due to extensive bleeding. However, the optimal timing of surgery remains controversial. Methods: Twenty-six patients who underwent surgery for SHP between July 1999 and December 2017 at our institution were retrospectively investigated. Results: Nineteen patients underwent emergent surgery (ES) and 7 underwent sub-emergent surgery (sub-ES). The ES group exhibited significantly higher drainage volume before

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... urgery compared to the sub-ES group (blood loss; 512 ml vs. 258 ml, p=0.019), and higher total hemorrhage volume (1,056 ml vs. 458 ml, p=0.022). One sub-ES group patient, whose preoperative blood loss measured 150 ml, went into shock prior to surgery. His chest roentgenograms did not indicate significant hemorrhage in the thorax; however, his total blood loss measured 1,100 ml. Conclusions: The optimal timing of surgical intervention for SHP may depend on the extent of preoperative blood loss. However, preoperative drainage volume is not an accurate indicator of total blood loss, and chest radiographic findings are not reliable in some cases. Therefore, patients with SHP must be carefully monitored, and surgical treatment should proceed smoothly from conservative management as necessary. Materials and Methods Patients Our study cohort comprised 26 consecutive patients with SHP who had undergone video-assisted thoracoscopic surgery (VATS) at Japanese Red Cross Maebashi Hospital