Modern Management of Traumatic Hemothorax

Mahoozi, Hamid Reza; Volmerig, Jan; Hecker, Erich

doi:10.4172/2167-1222.1000326

Cited by 13 publications

(15 citation statements)

References 24 publications

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“…In addition, open thoracotomy can be performed in the patient who is not a candidate for the VATS. 2 Among the endovascular treatment of an arterial rupture, the techniques include coil embolization and stent graft placement and are preferred for hemodynamically stable patients; these procedures require more time for planning and preparation. 9 The spasmodic cough in this patient was likely due to status asthmaticus.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to trauma, the non-traumatic hemothorax can be encountered in several diseases processes such as thoracic malignancies and metastasis, infections, tuberculosis, pulmonary arteriovenous malformation (AVM), pulmonary embolism, iatrogenic during thoracentesis or central venous access, and abnormal anatomy. 1,2 The hemothorax may be seen due to injury to the chest wall compromising the intercostal arteries or can be due to pulmonary, diaphragmatic, vascular, and mediastinal injuries compromising bronchial arteries or major vascular structures. Cough-induced hemothorax presenting to the emergency department (ED) is rare.…”

Section: Introductionmentioning

confidence: 99%

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Hemothorax induced by severe cough: An unusual presentation

Camarillo-Reyes

Marquez-Córdova

Surani

et al. 2019

SAGE Open Medical Case Reports

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Massive hemothorax resulting from cough-induced rib fracture is a condition in which blood accumulates in the chest, compromising the lungs and mediastinal structures. The most common cause of massive hemothorax is acute pro-traumatic injury. We present a case of a 47-year-old gentleman with morbid obesity and psoriasis, who was admitted to the emergency department due to shortness of breath that has been increased progressively after coughing for a period of 2 weeks. Chest radiograph demonstrated a large density in the left hemithorax, collapsing the left lung. Chest computerized tomography showed a left seventh rib fracture and massive pleural effusion. A closed chest tube thoracostomy was performed draining 3 L of hemorrhagic effusion, likely due to bleeding from the intercostal artery tear due to severe and prolonged cough. Cough-induced hemothorax due to spontaneous rib fractures are rare and clinicians should be well aware of this entity to prevent hemorrhagic shock and organ damage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hemothorax induced by severe cough: An unusual presentation

Camarillo-Reyes

Marquez-Córdova

Surani

et al. 2019

SAGE Open Medical Case Reports

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show abstract

“…In the study conducted by Sirmali et al 86.3% of patients who died following blunt chest trauma had rib fractures equal to or greater than six. Furthermore, bilateral rib fractures are associated with a higher incidence of chest‐related morbidity and mortality due to codominant lung and parenchymal injury, with the incidence of chest‐related death increasing significantly when bilateral fractures are present.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

Napier

2019

Sonography

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Rib fracture is reported to be the most commonly encountered aetiology following blunt chest trauma, 1,2 but despite this, it is frequently regarded as insignificant. Unfortunately, this ideology is compounded when the limitations of conventional imaging modalities are evaluated. In the acute setting, plain radiography can render rib fractures undetected in 50% of cases, 3 and although computer tomography (CT) is deemed to have a higher sensitivity than plain film, its limitations can include a lower specificity in the setting of higher radiation doses. 4,5 Regarded as being a sentinel injury, a rib fracture can act as an external marker to more serious pathologies 5-7 which can in turn compromise the normal breathing mechanism and/or the status of the thoraco-abdominal organs. As delayed diagnosis can result in increased patient morbidity and mortality, resulting from both primary and secondary complications, the detection of rib fracture is imperative in not only predicting patient outcomes but in the development of appropriate management pathways. 2,8 The aim of this case study is therefore twofold-it evaluates the sequelae that can result from rib fracture irrespective of how trivial the injury may seemand in doing so acknowledges the importance of correctly identifying this pathology in the acute setting. Secondly, it highlights a case where ultrasound detected rib fractures not seen on original plain radiographs, but suspected on magnetic resonance imaging (MRI) in a setting where CT of the chest was not performed. | CASE DESCRIPTIONA 37-year-old female presented to the emergency department following a high-speed motor vehicle accident (MVA) in which she was the front seat passenger. Suspicion was raised as to the presence of a retro-peritoneal bleed or hollow organ perforation upon sighting extensive thoraco-abdominal swelling and haematoma in conjunction with a tachycardic heart rhythm of 110 to 130 beats per minute. The initial chest radiograph was deemed unremarkable with normal cardio-mediastinal contours and clear lung fields. No evidence of pneumothorax or displaced rib injury was detected despite the patient complaining of slight chest discomfort on inspiration.As this woman was of child-bearing age and a radiation worker, doctors were hesitant to perform a CT scan initially, and as such intravenous fluids were hung and a period of observation undertaken in the hope that the tachycardia would subside. An ECG eight hours post MVA continued to demonstrate a tachycardic rhythm, and so it was decided to perform an abdominal ultrasound to exclude any intraperitoneal bleeding. No free fluid or solid organ lacerations were detected on the ultrasound scan. As mesenteric shearing could not be excluded by ultrasound, a CT was requested of the abdomen and pelvis. The results were again unremarkable, and the patient was observed overnight in case any pathology developed in the critical hours post trauma. Nine hours later, the patient's heart rate had dropped below 100 beats per minute, her chest sounds were cle...

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“…Thoracic injury accounts for 60% of all trauma cases (1). Injuries may range from simple rib fractures to complex cardiac or tracheobronchial injuries.…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic surgery in trauma: pros and cons

2019

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Thoracic injuries account for 60% of all trauma presentations. These patients often have extrathoracic injuries adding to the complexity of their management. Morbidity and the associated mortality are significantly increased in the elderly. The majority of cases will comprise of simple rib fractures, requiring adequate analgesia. In those that require surgical intervention, the use of video-assisted thoracoscopic surgery (VATS) is becoming increasingly more popular. VATS can often provide greater visualisation of the intrathoracic structures, whilst limiting the burden of injury to smaller non-rib spreading incisions. It is therefore becoming increasingly used as a diagnostic tool to identify the extend of the injuries whilst also allowing for therapeutic intervention. These benefits translate into decreased rate of post-operative complications and a shorter length of inpatient stay. We also discuss the relative contra-indications and cautions to the use of VATS in the setting of trauma.

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Modern Management of Traumatic Hemothorax

Cited by 13 publications

References 24 publications

Hemothorax induced by severe cough: An unusual presentation

Hemothorax induced by severe cough: An unusual presentation

Ultrasound in the diagnosis of rib fracture following blunt chest trauma: a case study

Video-assisted thoracoscopic surgery in trauma: pros and cons

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