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hemothorax
Etiology:
- central venous catheter placement
- subclavian vein > internal jugular vein
Pathology:
- blood in the pleural cavity
Clinical manifestations:
- deviation of trachea
- dullness to percussion over the affected chest
Radiology:
- portable chest X-ray delays treatment of tension hemothorax
Differential diagnosis:
- pneumothorax:
- hyperresonant to percussion over the affected chest
- hemopneumothorax
Management:
- immediate decompression of the affected side with a large-bore chest tube (> 36 French) for hypotension (tension hemothorax)
- hemothorax detected only with CT, but not chest X-ray often observed rather than thoracostomy [3]
- case presentation [1] suggests needle decompression not indicated*
* possible hemopneumothorax not discussed [1]
Specific
hemopneumothorax
General
pleural disorder
internal hemorrhage
sign/symptom
References
- NEJM Knowledge+ Question of the Week. Nov 15, 2016
http://knowledgeplus.nejm.org/question-of-week/314/
- Kritek PA
Distinguishing Between a Hemothorax and a Pneumothorax.
https://knowledgeplus.nejm.org/blog/distinguishing-between-a-hemothorax-and-a-pneumothorax/
- Mowery NT, Gunter OL, Collier BR et al.
Practice management guidelines for management of hemothorax
and occult pneumothorax.
J Trauma 2011 Feb 11; 70:510
PMID: 21307755
- Rodriguez RM, Canseco K, Baumann BM et al.
Pneumothorax and hemothorax in the era of frequent chest
computed tomography for the evaluation of adult patients with
blunt trauma.
Ann Emerg Med 2018 Oct 1; S0196-0644(18)31159-4;
PMID: 30287121