Chronic Expanding Hematoma Complicated by Life Threatening Hemoptysis and Respiratory Arrest—A Case Report

Chronic expanding hematoma (CEH) is a rare, indolent entity mostly linked to prior tuberculosis, thoracic surgery or trauma, with gradual long-term enlargement and potentially fatal complications. We present a 73-year-old Nepalese male without classic predisposing risk factors, presenting with mild hemoptysis in 2017 and a large right pleural hematoma on computed tomography (CT). He declined surgical evacuation and later developed progressive hematoma expansion and subsequent life-threatening hemoptysis complicated by type 2 respiratory failure and suspected bronchopleural fistula in 2025. He was deemed inoperable, failed conservative management and succumbed to nosocomial pneumonia. Post-mortem histology confirmed CEH with dense fibrous tissue and organized blood clot. This case highlights early recognition and surgical intervention as critical for CEH, even in patients without antecedent thoracic insult.