Postpartum shoulder pain and shortness of breath

A 29-year-old woman developed increasing right (Rt.) shoulder/chest pain and dyspnoea 16 hours after delivering a healthy baby. Neurofibromatosis type 1 (NF-1) had been diagnosed in childhood by cafe-au-lait macules, neurofibromas and a positive family history. She appeared acutely ill with tachycardia (120/min), tachyponea (20/min) and hypoxaemia (88% oxygen saturation). Breath sounds were barely audible over the Rt. hemithorax which was dull on percussion. ECG showed sinus tachycardia. Chest X-ray revealed large Rt. pleural effusion (figure 1). Laboratory tests were non-contributory except for serum Na 133 mEq/L due to the syndrome of inappropriate antidiuretic hormone secretion. CT angiography revealed massive Rt. haemothorax and demonstrated active …