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Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Massive haemothorax is usually caused by penetrating injury, but it can result from blunt trauma. Life-threatening haemothorax can be due to major lung parenchymal laceration, injury to the pulmonary hilum or direct cardiac laceration. Each hemithorax can accommodate more than half of a patient’s blood volume before physical signs become obvious.17 As well as causing hypotension due to blood loss, a massive haemothorax will also occupy space in the thoracic cavity normally occupied by lung, and the subsequent lung collapse will result in hypoxia. The signs of massive haemothorax are those of hypovolaemic shock together with, on the ipsilateral side: Dullness to percussionAbsent or reduced breath soundsDecreased expansion Immediate treatment begins with achieving large-calibre intravenous access. This must be accomplished before any attempt is made to drain a massive haemothorax. Emergency blood product administration should be considered early. However, until a significant cardiac or vascular injury has been ruled out, the systemic pressure should not be allowed to rise uncontrollably, as this may precipitate further haemorrhage.
Thoracic trauma
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Pneumothorax and hemothorax are the second most common thoracic injuries. In about two-thirds of cases, these injuries are associated with significant additional thoracic and non-thoracic injury. Pneumothorax may be due to injury to the chest wall, lung parenchyma, tracheobronchial tree, or esophagus. Pneumothorax and hemothorax may be asymptomatic or present with respiratory distress, chest pain, failure to maintain oxygen saturation, tenderness of the chest wall, crepitus from subcutaneous emphysema, decreased air entry on the affected side, and tracheal deviation to the unaffected side. Simple pneumothorax has the propensity to progress to tension pneumothorax due to the relatively mobile mediastinum in children, while a large hemothorax may not be immediately recognized and result in hemorrhagic shock. This is especially true in younger children in whom the clinical features of hypotension are often masked until the time of catastrophic decompensation. It is important to note that each hemithorax may hold up to 40% of a child's total blood volume.
The Chest
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Chest x-ray or eFAST will confirm the extent of blood loss, but most of the time tube thoracostomy is done immediately to relieve the threat of ventilatory embarrassment. If a gush of blood is obtained when the chest tube is placed, autotransfusion should be considered. There are simple devices for this that should be available in all major trauma resuscitation centres. The only contraindication to autotransfusion is a high suspicion of hollow viscus injury. Lesser forms of haemothorax are usually diagnosed by routine chest x-ray.
Endometriotic lung cyst causing catamenial hemoptysis; a case report and review of literature
Published in Acta Chirurgica Belgica, 2022
Evelyne Verhulst, Celine Bafort, Carla Tomassetti, Albert Wolthuis, Didier Bielen, Johan Coolen, Birgit Weynand, Lieven Platteeuw, Christel Meuleman, Dirk Van Raemdonck
Symptoms are largely correlated to the anatomic location of the lesions. The typical presentation of pleural TES is catamenial pneumothorax and chest or shoulder pain. This catamenial pneumothorax is recurrent, starting typically within 72 h after the onset of menstruation. Patients complain of chest pain, cough and shortness of breath. Diaphragmatic irritation can cause referred pain to the peri-scapular region or the neck [2,12]. In 92% of the cases, the right hemithorax is involved, in 5% the left hemithorax and 3% of patients have bilateral involvement. Catamenial hemothorax is less common for pleural TES with symptoms similar to a pneumothorax: cough, shortness of breath and pleuritic chest pain in addition to a bloody pleural effusion. Mild to moderate catamenial hemoptysis can also be caused by broncho-pulmonary TES, identified on imaging as pulmonary nodules varying in size from 0.5 to 3 cm. These lung nodules can occur in symptomatic patients, but they can also be an incidental finding [13]. Rarely, isolated diaphragmatic endometriosis can cause irritation of the phrenic nerve, producing cyclic neck, shoulder, right upper quadrant or epigastric pain.
Lung transplantation for COVID-19 associated ARDS: patience is a virtue
Published in Expert Review of Respiratory Medicine, 2022
Pleural complications often tend to be recalcitrant among these patients [14]. They pose a significant challenge due to the severity of underlying lung disease and a high risk of bleeding complications with a pneumothorax often getting complicated by hemothorax. Unless the situation is emergent, the standard approach of bedside placement of large-bore chest tubes may not be suitable due to the loculated nature of pleural complications. We have found the image-guided placement of smaller-bore chest tubes to be less likely to cause complications. The development of hemothorax may necessitate surgical interventions, sometimes multiple times, to permit the underlying lung to expand. While difficult to manage pleural complications can significantly limit the chances of pulmonary recovery, a hostile pleural space also has a bearing on their surgical candidacy for LT. Indeed, dense pleural adhesions pose one of the most significant challenges in explanting the native lungs during transplant surgery.
Current opinion and comparison of surgical procedures for the treatment of primary spontaneous pneumothorax
Published in Expert Review of Respiratory Medicine, 2022
Kenji Tsuboshima, Masatoshi Kurihara, Kuniaki Seyama
In a randomized controlled trial, Rena et al. assigned 108 patients who underwent VATS bullectomy with apical pleurectomy and 112 patients underwent VATS bullectomy with pleural abrasion for PSP [40]. The recurrence rates were 4.6% and 6.2%, respectively, with no significant difference. In a retrospective study by Ng et al., the prevention of recurrence was evaluated in 107 patients with PSP by comparing VATS bullectomy with partial pleurectomy (n = 73) and pleural abrasion (n = 34) [41]. Although there was no significant difference in major postoperative complications, three patients (4.1%) in the partial pleurectomy group required reoperation for hemothorax. The incidence of recurrence in patients who underwent partial pleurectomy (n = 1, 1.4%) was significantly lower than in those who underwent pleural abrasion (n = 8, 23.5%). Dżeljilji et al. evaluated 73 patients with PSP who underwent VATS pleurectomy from the top to the diaphragm with or without bullectomy in an observational study in 2019 [42]. Nine patients (12.3%) developed hemothorax, and four patients (5.5%) required re-operation. Postoperative recurrence occurred in four patients (5.5%). A retrospective study by Brophy et al. evaluated 35 patients with PSP who underwent pleurectomy with or without abrasion [43]. Postoperative recurrence was observed in only one case (2.9%), although no complications such as hemothorax or pain were described in detail. Cattoni M et al. researched 1178 patients with PSP underwent VATS in nine centers [44]. They showed that partial pleurectomy independently associated with chronic chest pain and paresthesia.