Hemothorax

Background

• Each hemithorax can hold 40% of circulating blood volume

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Diagnosis

• 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

Treatment

• Tube thoracostomy
  • Evacuation of >1500mL of blood immediately or 200mL/hr x 4hr = consider sx
• Autotransfuse lost blood if possible

See Also

• Thoracic Trauma
• Traumatic Pneumothorax
• Spontaneous Pneumothorax
• Tension Pneumothorax