Hemothorax natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Hemothorax}} | {{Hemothorax}} | ||
{{CMG}}; {{AE}} [[User:Irfan Dotani|Irfan Dotani]] | {{CMG}}; {{AE}} [[User:Irfan Dotani|Irfan Dotani]] {{JE}} | ||
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==Overview== | ==Overview== | ||
Bleeding into the pleural space is exposed to the motion of the [[Diaphragm (anatomy)|diaphragm]], | [[Bleeding]] into the [[Pleural cavity|pleural space]] is exposed to the motion of the [[Diaphragm (anatomy)|diaphragm]], [[lung]]s, and other intrathoracic structures. The agitation of cardiac and respiratory movement defibrinates the blood, and a [[fibrin]] [[clot]] thus formed is deposited on the layers of pleura. After several hours, [[Thrombus|clot]] formation is inevitable and it should be evacuated. if left untreated, it may progress to develop some complications. | ||
==Natural History== | ==Natural History== | ||
Bleeding into the pleural space is exposed to the motion of the [[Diaphragm (anatomy)|diaphragm]], lungs, and other intrathoracic structures. The agitation of cardiac and respiratory movement defibrinates the blood, and a [[fibrin]] [[clot]] thus formed is deposited on the layers of pleura. Within several hours of cessation of bleeding, clot formation is inevitable and it will be difficult to remove. The membrane continues to thicken by progressive deposition, so the clotted haemothorax should be evacuated within a reasonable time after the onset of bleeding. Chronic and retained hemothorax may progress to develop respiratory distress, lung entrapment with impaired pulmonary function, retained clot, chronic fibrothorax, [[Pleural empyema|empyema]] and extended hospitalization if left untreated. | [[Bleeding]] into the [[pleural cavity|pleural space]] is exposed to the motion of the [[Diaphragm (anatomy)|diaphragm]], lungs, and other intrathoracic structures. The agitation of cardiac and respiratory movement defibrinates the blood, and a [[fibrin]] [[clot]] thus formed is deposited on the layers of pleura. Within several hours of cessation of [[bleeding]], [[Thrombus|clot]] formation is inevitable and it will be difficult to remove. The membrane continues to thicken by progressive deposition, so the [[thrombus|clotted]] haemothorax should be evacuated within a reasonable time after the onset of [[bleeding]]. Chronic and retained hemothorax may progress to develop [[Respiratory failure|respiratory distress]], lung entrapment with impaired pulmonary function, retained [[Thrombus|clot]], chronic [[fibrothorax]], [[Pleural empyema|empyema]] and extended hospitalization if left untreated.<ref name="pmid24529771">{{cite journal| author=Janik M, Straka L, Krajcovic J, Hejna P, Hamzik J, Novomesky F| title=Non-traumatic and spontaneous hemothorax in the setting of forensic medical examination: a systematic literature survey. | journal=Forensic Sci Int | year= 2014 | volume= 236 | issue= | pages= 22-9 | pmid=24529771 | doi=10.1016/j.forsciint.2013.12.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24529771 }} </ref><ref name="pmid25813733">{{cite journal| author=Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N| title=VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax. | journal=Injury | year= 2015 | volume= 46 | issue= 9 | pages= 1749-52 | pmid=25813733 | doi=10.1016/j.injury.2015.02.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25813733 }} </ref><ref name="pmid20817498">{{cite journal| author=Boersma WG, Stigt JA, Smit HJ| title=Treatment of haemothorax. | journal=Respir Med | year= 2010 | volume= 104 | issue= 11 | pages= 1583-7 | pmid=20817498 | doi=10.1016/j.rmed.2010.08.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20817498 }} </ref><ref name="pmid26197910">{{cite journal| author=Miyahara S, Iwasaki A| title=[Diagnosis and Treatment of Hemothorax]. | journal=Kyobu Geka | year= 2015 | volume= 68 | issue= 8 | pages= 650-3 | pmid=26197910 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26197910 }} </ref><ref name="pmid18716687">{{cite journal| author=Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ| title=Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. | journal=Can Respir J | year= 2008 | volume= 15 | issue= 5 | pages= 255-8 | pmid=18716687 | doi=10.1155/2008/918951 | pmc=2679547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18716687 }} </ref> | ||
==Complications== | ==Complications== | ||
Common complications of hemothorax includeref name<ref name="pmid25813733">{{cite journal| author=Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N| title=VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax. | journal=Injury | year= 2015 | volume= 46 | issue= 9 | pages= 1749-52 | pmid=25813733 | doi=10.1016/j.injury.2015.02.028 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25813733 }} </ref><ref name="pmid20817498">{{cite journal| author=Boersma WG, Stigt JA, Smit HJ| title=Treatment of haemothorax. | journal=Respir Med | year= 2010 | volume= 104 | issue= 11 | pages= 1583-7 | pmid=20817498 | doi=10.1016/j.rmed.2010.08.006 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20817498 }} </ref><ref name="pmid18716687">{{cite journal| author=Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ| title=Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. | journal=Can Respir J | year= 2008 | volume= 15 | issue= 5 | pages= 255-8 | pmid=18716687 | doi=10.1155/2008/918951 | pmc=2679547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18716687 }} </ref><ref name="pmid29802756">{{cite journal| author=Tian Y, Zheng W, Zha N, Wang Y, Huang S, Guo Z| title=Thoracoscopic decortication for the management of trapped lung caused by 14-year pneumothorax: A case report. | journal=Thorac Cancer | year= 2018 | volume= 9 | issue= 8 | pages= 1074-1077 | pmid=29802756 | doi=10.1111/1759-7714.12770 | pmc=6068443 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29802756 }} </ref><ref name="pmid30070230">{{cite journal| author=Gleeson T, Blehar D| title=Point-of-Care Ultrasound in Trauma. | journal=Semin Ultrasound CT MR | year= 2018 | volume= 39 | issue= 4 | pages= 374-383 | pmid=30070230 | doi=10.1053/j.sult.2018.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30070230 }} </ref> | |||
* [[Respiratory failure|Respiratory distress]] | * [[Respiratory failure|Respiratory distress]] | ||
* Lung entrapment | * Lung entrapment | ||
* Impaired pulmonary function | * Impaired pulmonary function | ||
* Retained clot | * Retained [[Thrombus|clot]] | ||
* Chronic fibrothorax | * Chronic [[fibrothorax]] | ||
* [[Pleural empyema|Empyema]] | * [[Pleural empyema|Empyema]] | ||
* Extended hospitalization | * Extended [[hospital|hospitalization]] | ||
* [[Atelectasis]] | * [[Atelectasis]] | ||
* [[Pneumonia]] | * [[Pneumonia]] | ||
==Prognosis== | ==Prognosis== | ||
The [[morbidity]] and [[mortality rate]] of hemothorax correlates with the cause and the severity of the injury. Patients with retained hemothorax are at higher risk of developing [[empyema]] leading to prolonged [[Intensive care unit]]/[[hospital]] stay.<ref name="pmid30855807">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume= | issue= | pages= | pmid=30855807 | doi= | pmc= | url= }} </ref> | |||
==References== | ==References== | ||
Latest revision as of 20:48, 14 August 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Irfan Dotani Joanna Ekabua, M.D. [2]
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Overview
Bleeding into the pleural space is exposed to the motion of the diaphragm, lungs, and other intrathoracic structures. The agitation of cardiac and respiratory movement defibrinates the blood, and a fibrin clot thus formed is deposited on the layers of pleura. After several hours, clot formation is inevitable and it should be evacuated. if left untreated, it may progress to develop some complications.
Natural History
Bleeding into the pleural space is exposed to the motion of the diaphragm, lungs, and other intrathoracic structures. The agitation of cardiac and respiratory movement defibrinates the blood, and a fibrin clot thus formed is deposited on the layers of pleura. Within several hours of cessation of bleeding, clot formation is inevitable and it will be difficult to remove. The membrane continues to thicken by progressive deposition, so the clotted haemothorax should be evacuated within a reasonable time after the onset of bleeding. Chronic and retained hemothorax may progress to develop respiratory distress, lung entrapment with impaired pulmonary function, retained clot, chronic fibrothorax, empyema and extended hospitalization if left untreated.[1][2][3][4][5]
Complications
Common complications of hemothorax includeref name[2][3][5][6][7]
- Respiratory distress
- Lung entrapment
- Impaired pulmonary function
- Retained clot
- Chronic fibrothorax
- Empyema
- Extended hospitalization
- Atelectasis
- Pneumonia
Prognosis
The morbidity and mortality rate of hemothorax correlates with the cause and the severity of the injury. Patients with retained hemothorax are at higher risk of developing empyema leading to prolonged Intensive care unit/hospital stay.[8]
References
- ↑ Janik M, Straka L, Krajcovic J, Hejna P, Hamzik J, Novomesky F (2014). "Non-traumatic and spontaneous hemothorax in the setting of forensic medical examination: a systematic literature survey". Forensic Sci Int. 236: 22–9. doi:10.1016/j.forsciint.2013.12.013. PMID 24529771.
- ↑ 2.0 2.1 Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N (2015). "VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax". Injury. 46 (9): 1749–52. doi:10.1016/j.injury.2015.02.028. PMID 25813733.
- ↑ 3.0 3.1 Boersma WG, Stigt JA, Smit HJ (2010). "Treatment of haemothorax". Respir Med. 104 (11): 1583–7. doi:10.1016/j.rmed.2010.08.006. PMID 20817498.
- ↑ Miyahara S, Iwasaki A (2015). "[Diagnosis and Treatment of Hemothorax]". Kyobu Geka. 68 (8): 650–3. PMID 26197910.
- ↑ 5.0 5.1 Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ (2008). "Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury". Can Respir J. 15 (5): 255–8. doi:10.1155/2008/918951. PMC 2679547. PMID 18716687.
- ↑ Tian Y, Zheng W, Zha N, Wang Y, Huang S, Guo Z (2018). "Thoracoscopic decortication for the management of trapped lung caused by 14-year pneumothorax: A case report". Thorac Cancer. 9 (8): 1074–1077. doi:10.1111/1759-7714.12770. PMC 6068443. PMID 29802756.
- ↑ Gleeson T, Blehar D (2018). "Point-of-Care Ultrasound in Trauma". Semin Ultrasound CT MR. 39 (4): 374–383. doi:10.1053/j.sult.2018.03.007. PMID 30070230.
- ↑ "StatPearls". 2020. PMID 30855807.