II. Causes: Chest Traumatic Injury
- Lung Laceration
- Intercostal artery vessel injury
- Internal mammary vessel injury
- Thoracic Vertebral Fracture
III. Precautions
- Color of blood recovered from Hemothorax does not reliably differentiate arterial from venous source
IV. Management: Small Hemothorax (<300 cc)
- Size cutoff for small Hemothorax: 300 cc
- Evaluation by CT Chest
- XRay is inadequate to estimate Hemothorax size
- Calculation
- Estimate area of Hemothorax on an individual CT slice
- Multiply by the CT slice thickness
- Mulitply by the number of slices in which the Hemothorax appears
- Indications for standard Chest Tube drainage of small Hemothorax
- Symptomatic patient
- Subacute Hemothorax (cut-off for drainage is lower than standard 300 cc cutoff)
- Suspected superinfection of Hemothorax (empyema)
- Indications for small Pigtail Chest Catheter (8-16 french)
- Consider for a borderline size Hemothorax in an otherwise well patient
- Indications for observation of small Hemothorax
- Healthy asymptomatic patient
- Complications of an undrained small Hemothorax (uncommon)
- Retained Hemothorax
- Empyema (superinfected Hemothorax)
- Fibrothorax (lung trapped in Hemothorax)
- References
- Inaba in Majoewsky (2012) EM:Rap 12(11): 1
V. Management: Massive Hemothorax (>1500 ml or one third Blood Volume)
- Consider Autotransfusion device (e.g. hemovac, cell saver)
- Large bore Chest Tube (36-40 french) at the 5th intercostal space in the midaxillary line
- Operative management as below
VI. Precautions: Indications for operative management (thoracotomy)
- Chest Tube output >1500-2000 cc total or
- Chest Tube output 150-200 cc/hour for several hours or
- Refractory hemodynamic instability or
- Penetrating anterior Chest Trauma medial to the nipple line
Images: Related links to external sites (from Bing)
Related Studies
| Concepts | Injury or Poisoning (T037) |
| ICD10 | S27.1 |
| SnomedCT | 157331005, 210048005, 157329001, 269340000, 42458003 |
| English | traumatic hemothorax (diagnosis), traumatic hemothorax, Traumatic haemothorax (disorder), Haemothorax - traumatic, Hemothorax - traumatic, Traumatic haemothorax, Traumatic hemothorax, Traumatic hemothorax (disorder), hemothorax; traumatic, traumatic; hemothorax, Traumatic hemothorax, NOS |
| German | Traumatischer Haematothorax, Traumatischer Haemothorax |
| Korean | 외상성 혈액가슴증 |
| Czech | Traumatický hemotorax |
| Dutch | traumatische hemothorax, hemothorax; traumatisch, traumatisch; hemothorax, Traumatische hemothorax |
| French | Hémothorax traumatique |
| Hungarian | Traumás haemothorax |
| Italian | Emotorace traumatico |
| Japanese | 外傷性血胸, ｶﾞｲｼｮｳｾｲｹｯｷｮｳ |
| Spanish | Hemotórax traumático, hemotórax traumático (trastorno), hemotórax traumático |
| Portuguese | Hemotórax traumático |
Ontology: Traumatic pneumohemothorax (C0340008)
| Concepts | Injury or Poisoning (T037) |
| ICD9 | 860 |
| ICD10 | S27.2 |
| SnomedCT | 210049002, 157332003, 210050002, 233643006, 42434002 |
| English | Traum.pneumo/haemo-thorax NOS, Traumatic pneumo/haemo-thorax, Traumatic pneumothorax and haemothorax NOS, Traumatic pneumothorax and hemothorax NOS, pneumohemothorax traumatic, traumatic pneumohemothorax, traumatic pneumohemothorax (diagnosis), Traumatic haemopneumothorax (disorder), Traumatic pneumothorax and hemothorax NOS (disorder), Traumatic pneumothorax and hemothorax, Traumatic haemopneumothorax, Traumatic hemopneumothorax, Traumatic pneumothorax and haemothorax, Traumatic pneumohaemothorax, Traumatic pneumohemothorax, Traumatic pneumohemothorax (disorder), hemopneumothorax; traumatic, hemothorax; traumatic, with pneumothorax, pneumohemothorax; traumatic, pneumothorax; traumatic, with hemothorax, traumatic; hemopneumothorax, traumatic; hemothorax, with pneumothorax, traumatic; pneumohemothorax, traumatic; pneumothorax, with hemothorax, Traumatic hemopneumothorax, NOS, Traumatic pneumohaemothorax, NOS, Traumatic pneumohemothorax, NOS |
| German | Traumatischer Haematopneumothorax, traumatischer Pneumothorax und Haemothorax, traumatischer Pneumohaemothorax |
| Korean | 외상성 혈액공기가슴증 |
| Spanish | neumotórax y hemotórax traumáticos, SAI (trastorno), neumotórax y hemotórax traumáticos, SAI, Neumotórax y hemotórax traumáticos, Neumohemotórax traumático, Neumohemotorax traumático, hemoneumotórax traumático (trastorno), hemoneumotórax traumático, neumohemotórax traumático |
| Czech | Traumatický pneumohemotorax, Traumatický pneumotorax a hemotorax |
| Dutch | traumatische pneumothorax en hemothorax, traumatische pneumohemothorax, hemopneumothorax; traumatisch, hemothorax; traumatisch, met pneumothorax, pneumohemothorax; traumatisch, pneumothorax; traumatisch, met hemothorax, traumatisch; hemopneumothorax, traumatisch; hemothorax, met pneumothorax, traumatisch; pneumohemothorax, traumatisch; pneumothorax, met hemothorax, Traumatische hemopneumothorax |
| French | Pneumohémothorax traumatique, Pneumothorax et hémothorax traumatiques |
| Hungarian | Traumás pneumothorax és haemothorax, Traumás pneumohaemothorax |
| Italian | Pneumotorace ed emotorace traumatici, Pneumoemotorace traumatico, Emotorace e pneumotorace traumatico |
| Japanese | 外傷性気血胸, ｶﾞｲｼｮｳｾｲｷｹﾂｷｮｳ, ｶﾞｲｼｮｳｾｲｷｹｯｷｮｳ |
| Portuguese | Pneumemotórax traumático, Pneumotórax e hemotórax traumático |
