Hemothorax

Background
  • Each hemithorax can hold 40% of circulating blood volume

Clinical Features

Differential Diagnosis

Thoracic Trauma

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

Adult Chest Tube Sizes
Chest Tube Size Type of Patient Underlying Causes
Small (8-14 Fr)
  • Alveolar-pleural fistulae (small air leak)
  • Iatrogenic air
Medium (20-28 Fr)
  • Bronchial-pleural fistulae (large air leak)
  • Malignant fluid
Large (36-40 Fr)
  • Traumatic pneumothorax
    • 2012 study using 28-32 Fr tube just as good as 36-40 Fr tube. [1] This is reflected in the ATLS 2019 Guidelines: "ATLS ® -10 now recommends placement of a smaller 28F to 32F chest tube for any acute hemothorax that is visible on chest radiograph." [2]
  • Empyema
  • Bleeding (Hemothorax/hemopneumothorax)
  • Thick pus

See Also
  1. Inaba Et. al J Trauma Acute Care Surg. 2012 Feb;72(2):422-7.
  2. Advanced Trauma Life Support® Update 2019: Management and Applications for Adults and Special Populations.
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