Hemothorax

Excerpt

Hemothorax is a frequent consequence of traumatic thoracic injuries. It is a collection of blood in the pleural space, a potential space between the visceral and parietal pleura. The most common mechanism of trauma is a blunt or penetrating injury to intrathoracic or extrathoracic structures that result in bleeding into the thorax. Bleeding may arise from the chest wall, intercostal or internal mammary arteries, great vessels, mediastinum, myocardium, lung parenchyma, diaphragm, or abdomen.

CT scan is the preferred method of evaluation for intrathoracic injuries; however, it may not be feasible in the unstable trauma patient. Furthermore, smaller centers may not have CT scan readily available. Chest radiography has been used traditionally as a screening tool to evaluate for immediate life-threatening injuries. Recent literature suggests point-of-care ultrasound (POCUS) can be useful as an adjunct to traditional imaging modalities. POCUS is rapid, reliable, repeatable, and most importantly, portable. It is usable at the bedside for triage and identification of life-threatening injuries. Pulmonary windows have been included in the Extended-Focused Assessment with Sonography in Trauma (eFAST) protocol since the mid-2000s. In addition to the traditional right and left upper quadrant views of the FAST, the operator can slide the probe cephalad to evaluate quickly for the presence of fluid above the diaphragm. Multiple studies have shown that chest ultrasonography is a valuable tool in the diagnostic approach of patients with blunt chest trauma. Lung ultrasound (US) in the evaluation for hemothorax has demonstrated accuracy, with higher sensitivity than chest radiography.