Management of post-traumatic retained hemothorax

Joseph D. Bozzay*, Matthew J. Bradley

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations

Abstract

Introduction: Chest injuries occur in a significant portion of trauma patients and hemothorax is a common result. While the initial management of traumatic hemothorax is most commonly treated with tube thoracostomy, the management of retained hemothorax is a subject of debate. Recent literature has proposed different methods for treating or preventing retained hemothorax, yet the approach to this pathology is not straightforward. Methods: The literature was reviewed for relevant studies regarding the prevention and management of post-traumatic retained hemothorax. What follows is a review of the recent literature and an algorithm for the approach to treating a traumatic retained hemothorax. Results: Identifying a traumatic retained hemothorax and preventing subsequent complications such as pneumonia, empyema, and fibrothorax are significant issues faced by surgeons. Studies for preventing retained hemothorax have focused on initial chest tube size, location, and peri-procedural placement conditions, as well as thoracic lavage. Several treatment modalities exist, including second drainage procedure and intra-pleural fibrinolytic drug instillation, but video-assisted thoracoscopic surgery is the most common and successful approach. Regardless of the approach to evacuation, early intervention is paramount. Conclusion: Further studies will help characterize appropriate candidates, timing, treatment modalities, and guide therapy for retained hemothorax.

Original languageEnglish
Pages (from-to)14-20
Number of pages7
JournalTrauma (United Kingdom)
Volume21
Issue number1
DOIs
StatePublished - 1 Jan 2019
Externally publishedYes

Keywords

  • Chest tube
  • chest trauma
  • empyema
  • fibrothorax
  • pneumonia
  • retained hemothorax
  • tube thoracostomy
  • video-assisted thoracoscopic surgery

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