Hemothorax, Massive Hemothorax, Traumatic Pneumohemothorax, Traumatic hemothorax

  • See Also
  1. Lung Laceration
  2. Intercostal artery vessel injury
  3. Internal mammary vessel injury
  4. Thoracic Vertebral Fracture
  • Precautions
  1. Color of blood recovered from Hemothorax does not reliably differentiate arterial from venous source
  • Management
  • Small Hemothorax (<300 cc)
  1. Size cutoff for small Hemothorax: 300 cc
    1. Dubose (2012) Trauma Acute Care 72(1): 11-22 [PubMed]
  2. Evaluation by CT Chest
    1. XRay is inadequate to estimate Hemothorax size
  3. Calculation
    1. Estimate area of Hemothorax on an individual CT slice
    2. Multiply by the CT slice thickness
    3. Mulitply by the number of slices in which the Hemothorax appears
  4. Indications for standard Chest Tube drainage of small Hemothorax
    1. Symptomatic patient
    2. Subacute Hemothorax (cut-off for drainage is lower than standard 300 cc cutoff)
    3. Suspected superinfection of Hemothorax (empyema)
  5. Indications for small Pigtail Chest Catheter (8-16 french)
    1. Consider for a borderline size Hemothorax in an otherwise well patient
  6. Indications for observation of small Hemothorax
    1. Healthy asymptomatic patient
  7. Complications of an undrained small Hemothorax (uncommon)
    1. Retained Hemothorax
    2. Empyema (superinfected Hemothorax)
    3. Fibrothorax (lung trapped in Hemothorax)
  8. References
    1. Inaba in Majoewsky (2012) EM:Rap 12(11): 1
  • Management
  • Massive Hemothorax (>1500 ml or one third Blood Volume)
  1. Consider Autotransfusion device (e.g. hemovac, cell saver)
  2. Large bore Chest Tube (36-40 french) at the 5th intercostal space in the midaxillary line
  3. Operative management as below
  • Precautions
  • Indications for operative management (thoracotomy)
  1. Chest Tube output >1500-2000 cc total or
  2. Chest Tube output 150-200 cc/hour for several hours or
  3. Refractory hemodynamic instability or
  4. Penetrating anterior Chest Trauma medial to the nipple line
  • References
  1. (2012) ATLS 9th ed, American College of Surgeons, Committee on Trauma, p. 96-9