Hemothorax: Difference between revisions

Revision as of 13:08, 10 April 2021

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

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

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

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

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

Authors:

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 ==Background==
+[[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