Hemothorax: Difference between revisions
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==Background== | ==Background== | ||
[[File:Lung and diaphragm.jpg|thumb|Lobes of the lung with related anatomy.]] | |||
[[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 | *Each hemithorax can hold 40% of circulating blood volume | ||
==Clinical Features== | ==Clinical Features== | ||
*Diminished or absent breath sounds | |||
*Dullness to percussion | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
== | ==Evaluation== | ||
*CXR | [[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 | **Upright - Fluid collections >200-300cc can usually be seen | ||
**Supine - Fluid collections >1000cc can be missed | **Supine - Fluid collections >1000cc can be missed | ||
**Mainstem bronchus intubation can appear like a hemothorax on CXR | **Mainstem bronchus intubation can appear like a hemothorax on CXR | ||
*US | *[[lung ultrasound|US]] | ||
*CT is gold standard | *CT is gold standard | ||
== | ==Management== | ||
*[[Tube thoracostomy]] | *[[Tube thoracostomy]] | ||
**Evacuation of | **Evacuation of 1000-1500mL of blood immediately or 200mL/hr x 4hr = consider [[thoracotomy]] | ||
*Autotransfuse lost blood if possible | *Autotransfuse lost blood if possible | ||
{{Chest tube size table}} | {{Chest tube size table}} | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
*[[Thoracic | *[[Thoracic trauma]] | ||
*[[Traumatic | *[[Traumatic pneumothorax]] | ||
*[[Spontaneous | *[[Spontaneous pneumothorax]] | ||
*[[Tension | *[[Tension pneumothorax]] | ||
==External Links== | |||
[[Category: | ==References== | ||
[[Category:Pulmonary]] | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Latest revision as of 18:39, 24 April 2024
Background
- 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
- Musculoskeletal
- Other
Evaluation
CXR with large right sided hemothorax (and widened mediastinum).
- 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) |
|
|
| Medium (20-28 Fr) |
|
|
| Large (36-40 Fr) |
|
Disposition
- Admit