Hemothorax: Difference between revisions

Revision as of 09:25, 9 September 2016

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

@@ Line 1: / Line 1: @@
-*From trauma
+==Background==
-*Each hemithorax and hold 40% of circulating blood volume
+*Each hemithorax can hold 40% of circulating blood volume
-*CXR
-**Hemithorax is completely opacified
+==Clinical Features==
-***Mainstem bronchus intubation can appear like a hemorthorax on CXR
-*Tx
+==Differential Diagnosis==
-**Tube thoracostomy
+{{Thoracic trauma DDX}}
-***Evacuation of >1500mL of blood immediately or 200mL/hr x 4hr = operative management
-**Autotransfuse lost blood if possible
+==Evaluation==
+*[[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 >1500mL of blood immediately or 200mL/hr x 4hr = consider [[thoracotomy]]
+*Autotransfuse lost blood if possible
+{{Chest tube size table}}
+==See Also==
+*[[Thoracic Trauma]]
+*[[Traumatic Pneumothorax]]
+*[[Spontaneous Pneumothorax]]
+*[[Tension Pneumothorax]]
+[[Category:Pulmonary]]
+[[Category:Trauma]]