Hemothorax: Difference between revisions

Latest revision as of 18:39, 24 April 2024

Background

Lobes of the lung with related anatomy.

Pleural cavity normally a potential space, in which blood collects in a hemothorax.

Each hemithorax can hold 40% of circulating blood volume

Clinical Features

Diminished or absent breath sounds
Dullness to percussion

Differential Diagnosis

Thoracic Trauma

Airway/Pulmonary
Cardiac/Vascular
- Cardiac injury
- Traumatic aortic transection
Musculoskeletal
Other

Evaluation

CXR with large right sided hemothorax (and widened mediastinum).

Ultrasound scan of the chest showing a left-sided hemothorax.

CT chest of right sided hemothorax.

CXR
- Upright - Fluid collections >200-300cc can usually be seen
- Supine - Fluid collections >1000cc can be missed
- Mainstem bronchus intubation can appear like a hemothorax on CXR
US
CT is gold standard

Management

Tube thoracostomy
- Evacuation of 1000-1500mL of blood immediately or 200mL/hr x 4hr = consider thoracotomy
Autotransfuse lost blood if possible

Adult Chest Tube Sizes

Chest Tube Size	Type of Patient	Underlying Causes
Small (8-14 Fr)	Most spontaneous pneumothorax (primary and secondary) Most iatrogenic pneumothorax	Alveolar-pleural fistulae (small air leak) Iatrogenic air
Medium (20-28 Fr)	Traumatic pneumothorax Traumatic hemothorax ("any acute hemothorax visible on chest radiograph")^[1]^[2] Pneumothorax on mechanical ventilation Non-traumatic tension pneumothorax Malignant effusion	Trauma/bleeding (hemothorax/hemopneumothorax) Bronchial-pleural fistulae (large air leak) Malignant fluid
Large (36-40 Fr)	Empyema	Thick pus

Disposition

Admit

External Links

References

Authors:

[1] Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.

[2] Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.

[1]

[2]

@@ Line 1: / Line 1: @@
 ==Background==
-*Typically from trauma
+[[File:Lung and diaphragm.jpg|thumb|Lobes of the lung with related anatomy.]]
-*Each hemithorax and hold 40% of circulating blood volume
+[[File:2313 The Lung Pleurea.jpg|thumb|Pleural cavity normally a potential space, in which blood collects in a hemothorax.]]
+*Each hemithorax can hold 40% of circulating blood volume
-==Diagnosis==
+==Clinical Features==
-*CXR
+*Diminished or absent breath sounds
-**Hemithorax is completely opacified
+*Dullness to percussion
-***Mainstem bronchus intubation can appear like a hemorthorax on CXR
-==Treatment==
+==Differential Diagnosis==
-*Tube thoracostomy
+{{Thoracic trauma DDX}}
-**Evacuation of >1500mL of blood immediately or 200mL/hr x 4hr = operative management
+==Evaluation==
+[[File:Massive right hemothorax.jpg|thumb|[[CXR]] with large right sided hemothorax (and widened mediastinum).]]
+[[File:UOTW 38 - Ultrasound of the Week 4.jpg|thumb|Ultrasound scan of the chest showing a left-sided hemothorax.]]
+[[File:CT scan showing hemothorax caused by warfarin use.png|thumb|CT chest of right sided hemothorax.]]
+*[[CXR]]
+**Upright - Fluid collections >200-300cc can usually be seen
+**Supine - Fluid collections >1000cc can be missed
+**Mainstem bronchus intubation can appear like a hemothorax on CXR
+*[[lung ultrasound|US]]
+*CT is gold standard
+==Management==
+*[[Tube thoracostomy]]
+**Evacuation of 1000-1500mL of blood immediately or 200mL/hr x 4hr = consider [[thoracotomy]]
 *Autotransfuse lost blood if possible
+{{Chest tube size table}}
+==Disposition==
+*Admit
 ==See Also==
-*[[Thoracic Trauma]]
+*[[Thoracic trauma]]
-*[[Traumatic Pneumothorax]]
+*[[Traumatic pneumothorax]]
-*[[Spontaneous Pneumothorax]]
+*[[Spontaneous pneumothorax]]
-*[[Tension Pneumothorax]]
+*[[Tension pneumothorax]]
+==External Links==
-[[Category:Pulm]]
+==References==
+[[Category:Pulmonary]]
 [[Category:Trauma]]