Treatment strategies for chronic expanding hematomas of the thorax

Abstract

Purpose: To investigate retrospectively the treatment strategies for chronic expanding hematoma (CEH) of the thorax.

Methods: We reviewed the medical records of six patients treated for CEH of the thorax at our institution between October 1996 and October 2006.

Results: All of the patients had a history of thoracic surgery or tuberculosis with a latent period of 12-55 years before onset. One elderly patient with ischemic heart disease and in poor general health demonstrated a substantial improvement of symptoms after undergoing arterial embolization twice instead of surgery. The remaining five patients underwent either pleuropneumonectomy or a total capsule excision, following which their clinical condition improved remarkably. All six patients were discharged from the hospital. Arterial embolization was performed before surgery, and the amount of intraoperative bleeding ranged from 905 ml to 6,590 ml (average: 2,396 ml).

Conclusion: Chronic expanding hematoma of the thorax may occur after thoracic surgery and a tuberculosis infection; however, considering the risk of massive bleeding during surgery, the decision to perform surgery should be made with extreme care.