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Hemothorax, Pneumothorax, and Empyema

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Common Problems in Acute Care Surgery

Abstract

Pneumothorax (PTX), hemothorax (HTX), and empyema are the most common pleural-based problems encountered by the acute care surgeon. Timely recognition and intervention can usually abort what would otherwise be highly morbid disease processes. This chapter discusses the presentation, diagnostic features, and current treatment strategies for these entities.

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References

  1. Di Bartolomeo S, Sanson G, Nardi G, et al. A population-based study on pneumothorax in severely traumatized patients. J Trauma. 2001;51:677–82.

    Article  PubMed  Google Scholar 

  2. Ball CG, Dente CJ, Kirkpatrick AW, et al. Occult pneumothoraces in patients with penetrating trauma: does mechanism matter? Can J Surg. 2010;53:251–5.

    PubMed  Google Scholar 

  3. Sahn SA, Heffner JE. Spontaneous pneumothorax. N Engl J Med. 2000;342:868–74.

    Article  PubMed  CAS  Google Scholar 

  4. Lu A, Aronowitz P. Pneumothorax in a patient with COPD after blunt trauma. J Hosp Med. 2010;5:E34–5.

    Article  PubMed  Google Scholar 

  5. Celik B, Sahin E, Nadir A, et al. Iatrogenic pneumothorax: etiology, incidence and risk factors. Thorac Cardiovasc Surg. 2009;57:286–90.

    Article  PubMed  CAS  Google Scholar 

  6. Haynes D, Baumann MH. Management of pneumothorax. Semin Respir Crit Care Med. 2010;31:769–80.

    Article  PubMed  Google Scholar 

  7. Noppen M. Spontaneous pneumothorax: epidemiology, pathophysiology and cause. Eur Respir Rev. 2010;19:217–9.

    Article  PubMed  CAS  Google Scholar 

  8. Murali R, Park K, Leslie KO. The pleura in health and disease. Semin Respir Crit Care Med. 2010;31:649–73.

    Article  PubMed  Google Scholar 

  9. Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17:11–7.

    Article  PubMed  Google Scholar 

  10. Dulchavsky SA, Schwarz KL, Kirkpatrick AW, et al. Prospective evaluation of thoracic ultrasound in the detection of pneumothorax. J Trauma. 2001;50:201–5.

    Article  PubMed  CAS  Google Scholar 

  11. Mariani PJ, Wittick L. Pneumothorax diagnosis by extended focused assessment with sonography for trauma. J Ultrasound Med. 2009;28:1601. author reply 2.

    PubMed  Google Scholar 

  12. Surgeons ACo. ATLS—Advanced trauma life support course for doctors. 8th ed. Chicago, IL: American College of Surgeons; 2008.

    Google Scholar 

  13. Soldati G, Testa A, Sher S, et al. Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department. Chest. 2008;133:204–11.

    Article  PubMed  Google Scholar 

  14. Blaivas M, Lyon M, Duggal S. A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax. Acad Emerg Med. 2005;12:844–9.

    Article  PubMed  Google Scholar 

  15. Reddy VS. Minimally invasive techniqures in thoracic surgery. Semin Thorac Cardiovasc Surg. 2008;20:72–7.

    Article  PubMed  Google Scholar 

  16. Zengerink I, Brink PR, Laupland KB, et al. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle? J Trauma. 2008;64:111–4.

    Article  PubMed  Google Scholar 

  17. Brar MS, Bains I, Brunet G, et al. Occult pneumothoraces truly occult or simply missed: redux. J Trauma. 2010;69:1335–7.

    Article  PubMed  Google Scholar 

  18. Kaiser M, Whealon M, Barrios C, et al. The clinical significance of occult thoracic injury in blunt trauma patients. Am Surg. 2010;76:1063–6.

    PubMed  Google Scholar 

  19. Yadav K, Jalili M, Zehtabchi S. Management of traumatic occult pneumothorax. Resuscitation. 2010;81:1063–8.

    Article  PubMed  Google Scholar 

  20. Ball CG, Kirkpatrick AW, Feliciano DV. The occult pneumothorax: what have we learned? Can J Surg. 2009;52:E173–9.

    PubMed  Google Scholar 

  21. de Moya MA, Seaver C, Spaniolas K, et al. Occult pneumothorax in trauma patients: development of an objective scoring system. J Trauma. 2007;63:13–7.

    Article  PubMed  Google Scholar 

  22. Wilson H, Ellsmere J, Tallon J, et al. Occult pneumothorax in the blunt trauma patient: tube thoracostomy or observation? Injury. 2009;40:928–31.

    Article  PubMed  Google Scholar 

  23. Noppen M. The utility of thoracoscopy in the diagnosis and management of pleural disease. Semin Respir Crit Care Med. 2010;31:751–9.

    Article  PubMed  Google Scholar 

  24. Huber-Wagner S, Korner M, Ehrt A, et al. Emergency chest tube placement in trauma care—which approach is preferable? Resuscitation. 2007;72:226–33.

    Article  PubMed  Google Scholar 

  25. Fitzgerald M, Mackenzie CF, Marasco S, et al. Pleural decompression and drainage during trauma reception and resuscitation. Injury. 2008;39:9–20.

    Article  PubMed  CAS  Google Scholar 

  26. Schulman CI, Cohn SM, Blackbourne L, et al. How long should you wait for a chest radiograph after placing a chest tube on water seal? A prospective study. J Trauma. 2005;59:92–5.

    Article  PubMed  Google Scholar 

  27. Casos SR, Richardson JD. Role of thoracoscopy in acute management of chest injury. Curr Opin Crit Care. 2006;12:584–9.

    Article  PubMed  Google Scholar 

  28. Carrillo EH, Kozloff M, Saridakis A, et al. Thoracoscopic application of a topical sealant for the management of persistent posttraumatic pneumothorax. J Trauma. 2006;60:111–4.

    Article  PubMed  Google Scholar 

  29. Ahmed N, Jones D. Video-assisted thoracic surgery: state of the art in trauma care. Injury. 2004;35:479–89.

    Article  PubMed  CAS  Google Scholar 

  30. Paci M, Annessi V, de Franco S, et al. Videothoracoscopic evaluation of thoracic injuries. Chir Ital. 2002;54:335–9.

    PubMed  Google Scholar 

  31. Fabbrucci P, Nocentini L, Secci S, et al. Video-assisted thoracoscopy in the early diagnosis and management of post-traumatic pneumothorax and hemothorax. Surg Endosc. 2008;22:1227–31.

    Article  PubMed  Google Scholar 

  32. Divisi D, Battaglia C, De Berardis B, et al. Video-assisted thoracoscopy in thoracic injury: early or delayed indication? Acta Biomed Ateneo Parmense. 2004;75:158–63.

    Google Scholar 

  33. Meyer DM. Hemothorax related to trauma. Thorac Surg Clin. 2007;17:47–55.

    Article  PubMed  Google Scholar 

  34. LoCicero 3rd J, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989;69:15–9.

    PubMed  Google Scholar 

  35. Ng CS, Pang KK, Wong RH, et al. Spontaneous hemothorax: what is in a name? World J Surg. 2009;33:1780–1.

    Article  PubMed  Google Scholar 

  36. Molnar TF, Hasse J, Jeyasingham K, et al. Changing dogmas: history of development in treatment modalities of traumatic pneumothorax, hemothorax, and posttraumatic empyema thoracis. Ann Thorac Surg. 2004;77:372–8.

    Article  PubMed  Google Scholar 

  37. Livingston DH, Hauser CJ. Chest wall and lung. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 6th ed. New York: McGraw Hill Medical; 2008. p. 535–9.

    Google Scholar 

  38. Abboud PA, Kendall J. Emergency department ultrasound for hemothorax after blunt traumatic injury. J Emerg Med. 2003;25:181–4.

    Article  PubMed  Google Scholar 

  39. Sharma OP, Hagler S, Oswanski MF. Prevalence of delayed hemothorax in blunt thoracic trauma. Am Surg. 2005;71:481–6.

    PubMed  Google Scholar 

  40. Misthos P, Kakaris S, Sepsas E, et al. A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma. Eur J Cardiothorac Surg. 2004;25:859–64.

    Article  PubMed  CAS  Google Scholar 

  41. Crnjac A, Antonic J, Zorko A, et al. Video-assisted thoracic surgery–a new possibility for the management of traumatic hemothorax. Wien Klin Wochenschr. 2001;113 Suppl 3:18–20.

    PubMed  Google Scholar 

  42. Morrison CA, Lee TC, Wall Jr MJ, et al. Use of a trauma service clinical pathway to improve patient outcomes for retained traumatic hemothorax. World J Surg. 2009;33:1851–6.

    Article  PubMed  Google Scholar 

  43. Hagiwara A, Yanagawa Y, Kaneko N, et al. Indications for transcatheter arterial embolization in persistent hemothorax caused by blunt trauma. J Trauma. 2008;65:589–94.

    Article  PubMed  Google Scholar 

  44. Vassiliu P, Velmahos GC, Toutouzas KG. Timing, safety, and efficacy of thoracoscopic evacuation of undrained post-traumatic hemothorax. Am Surg. 2001;67:1165–9.

    PubMed  CAS  Google Scholar 

  45. Bilello JF, Davis JW, Lemaster DM. Occult traumatic hemothorax: when can sleeping dogs lie? Am J Surg. 2005;190:841–4.

    Article  PubMed  Google Scholar 

  46. Navsaria PH, Vogel RJ, Nicol AJ. Thoracoscopic evacuation of retained posttraumatic hemothorax. Ann Thorac Surg. 2004;78:282–5. discussion 5–6.

    Article  PubMed  Google Scholar 

  47. Tomaselli F, Maier A, Renner H, et al. Thoracoscopical water jet lavage in coagulated hemothorax. Eur J Cardiothorac Surg. 2003;23:424–5.

    Article  PubMed  Google Scholar 

  48. Villegas MI. Risk Factors associated with the development of post-traumatic retained hemothorax. Br J Trauma Emerg Surg 2010;

    Google Scholar 

  49. Macleod J, Ustin J, Kim J, et al. The epidemiology of traumatic hemothorax in a level 1 trauma center: case for early video-assisted thorascopic surgery. Eur J Trauma Emerg Surg. 2010;36:204–6.

    Article  Google Scholar 

  50. Karmy-Jones R, Holevar M, Sullivan RJ, et al. Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury. Can Resp J. 2008;15:255–8.

    Google Scholar 

  51. Kimbrell BJ, Yamzon J, Petrone P, et al. Intrapleural thrombolysis for the management of undrained traumatic hemothorax: a prospective observational study. J Trauma. 2007;62:1175–8. discussion 8–9.

    Article  PubMed  Google Scholar 

  52. Jerjes-Sanchez C, Ramirez-Rivera A, Elizalde JJ, et al. Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema: a multicenter trial. Chest. 1996;109:1514–9.

    Article  PubMed  CAS  Google Scholar 

  53. Eren S, Esme H, Sehitogullari A, et al. The risk factors and management of posttraumatic empyema in trauma patients. Injury. 2008;39:44–9.

    Article  PubMed  Google Scholar 

  54. Hoth JJ, Burch PT, Bullock TK, et al. Pathogenesis of posttraumatic empyema: the impact of pneumonia on pleural space infections. Surg Infect (Larchmt). 2003;4:29–35.

    Article  Google Scholar 

  55. Stewart RM, Corneille MG. Common complications following thoracic trauma: their prevention and treatment. Semin Thorac Cardiovasc Surg. 2008;20:69–71.

    Article  PubMed  Google Scholar 

  56. Aguilar MM, Battistella FD, Owings JT, et al. Posttraumatic empyema. Risk factor analysis. Arch Surg. 1997;132:647–50.

    Article  PubMed  CAS  Google Scholar 

  57. Bailey KA, Bass J, Rubin S, et al. Empyema management: twelve years’ experience since the introduction of video-assisted thoracoscopic surgery. J Laparoendosc Adv Surg Tech A. 2005;15:338–41.

    Article  PubMed  Google Scholar 

  58. Grijalva CG, Zhu Y, Nuorti JP, et al. Emergence of parapneumonic empyema in the USA. Thorax. 2011;66:663–8.

    Article  PubMed  Google Scholar 

  59. Society AT. Management of nontuberculous empyema. Am Rev Respir Dis. 1962;85:93.

    Google Scholar 

  60. Carrillo E, Williams M. Thoracic surgery. In: Civetta J, Taylor R, Kirby R, editors. Critical care. 3rd ed. Philadelphia: Lippincott—Raven; 1997. p. 1143.

    Google Scholar 

  61. Andrade-Alegre R, Garisto JD, Zebede S. Open thoracotomy and decortication for chronic empyema. Clinics. 2008;63:789–93.

    Article  PubMed  Google Scholar 

  62. Davies S, Richardson MC, Anthony FW, et al. Progesterone inhibits insulin-like growth factor binding protein-1 (IGFBP-1) production by explants of the Fallopian tube. Mol Hum Reprod. 2004;10:935–9.

    Article  PubMed  CAS  Google Scholar 

  63. Cameron R. Intraapleural fibrinolytic therapy versus conservative managementin the tratment of adult parapneumonic effusions and empyema. Cochrane Database Syst Rev. 2000;3:2312.

    Google Scholar 

  64. Ravitch MM, Steichen FM. Atlas of general thoracic surgery. Philadelphia: WB Saunders; 1988.

    Google Scholar 

  65. Pichlmaier H, Schildberg F. Thoracic surgery: surgical procedures on the chest and thoracic cavity. New York: Springer-Verlag; 1987.

    Google Scholar 

  66. Bryant RE, Salmon CJ. Pleural empyema. Clin Infect Dis. 1996;22:747–62.

    Article  PubMed  CAS  Google Scholar 

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Correspondence to Bruce J. Simon M.D. .

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Santry, H.P., Simon, B.J. (2013). Hemothorax, Pneumothorax, and Empyema. In: Moore, L., Turner, K., Todd, S. (eds) Common Problems in Acute Care Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6123-4_15

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  • DOI: https://doi.org/10.1007/978-1-4614-6123-4_15

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