BACKGROUND: Intrapleural blood detected by computed tomography scan, but not evident on plain chest radiograph, defines occult hemothorax. This study determined the role for tube thoracostomy. METHODS: Hemothorax was quantified on computed tomography by measuring the deepest lamellar fluid stripe at the most dependent portion. Data were collected prospectively on demographics, injury mechanism/severity, chest injuries, mechanical ventilation, hospital length of stay, complications, and outcome. Indications for tube thoracostomy were recorded. RESULTS: Tube thoracostomy was avoided in 67 patients (83%). Indications for chest tube placement included progression of hemothorax (8), desaturation (4), and delayed hemothorax (2). Patients with intrapleural fluid thickness greater than 1.5 cm were 4 times more likely to require tube thoracostomy. CONCLUSIONS: Occult hemothorax can be managed successfully without tube thoracostomy in most cases. Mechanical ventilation is not an indication for chest tube placement. Accompanying occult pneumothorax may be expected in 50% of cases, but did not affect clinical management.
BACKGROUND: Intrapleural blood detected by computed tomography scan, but not evident on plain chest radiograph, defines occult hemothorax. This study determined the role for tube thoracostomy. METHODS: Hemothorax was quantified on computed tomography by measuring the deepest lamellar fluid stripe at the most dependent portion. Data were collected prospectively on demographics, injury mechanism/severity, chest injuries, mechanical ventilation, hospital length of stay, complications, and outcome. Indications for tube thoracostomy were recorded. RESULTS: Tube thoracostomy was avoided in 67 patients (83%). Indications for chest tube placement included progression of hemothorax (8), desaturation (4), and delayed hemothorax (2). Patients with intrapleural fluid thickness greater than 1.5 cm were 4 times more likely to require tube thoracostomy. CONCLUSIONS: Occult hemothorax can be managed successfully without tube thoracostomy in most cases. Mechanical ventilation is not an indication for chest tube placement. Accompanying occult pneumothorax may be expected in 50% of cases, but did not affect clinical management.
Authors: I Mahmood; Z Tawfeek; S Khoschnau; S Nabir; A Almadani; H Al Thani; K Maull; R Latifi Journal: Eur J Trauma Emerg Surg Date: 2012-07-20 Impact factor: 3.693
Authors: Michael Paplawski; Swapna Munnangi; Jody C Digiacomo; Edwin Gonzalez; Ashley Modica; Shawndeep S Tung; Catherine Ko Journal: Crit Care Res Pract Date: 2019-09-02