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Occult hemopneumothorax following chest trauma does not need a chest tube

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

The increasing use of thoracic computed tomography (CT) in trauma patients has led to the recognition of intrapleural blood and air that are not initially evident on admission plain chest X-ray, defining the presence of occult hemopneumothorax. The clinical significance of occult hemopneumothorax, specifically the role of the tube thoracostomy, is not clearly defined.

Objective

To identify those patients with occult hemopneumothorax who can be safely managed without chest tube insertion.

Design

Prospective observational study.

Methods

During the recent 24 month period ending July 2010, comprehensive data on trauma patients with occult hemopneumothorax were recorded to determine whether tube thoracostomy was needed and, if not, to define the consequences of nondrainage. Pneumothorax and hemothorax were quantified by computed tomography (CT) measurement. Data included demographics, injury mechanism and severity, chest injuries, need for mechanical ventilation, indications for tube thoracostomy, hospital length of stay, complications and outcome.

Results

There were 73 patients with hemopenumothorax identified on CT scan in our trauma registry. Tube thoracostomy was successfully avoided in 60 patients (83 %). Indications for chest tube placement in 13 (17 %) of patients included X-ray evidence of hemothorax progression (10), respiratory compromise with oxygen desaturation (2). Mechanical ventilation was required in 19 patients, five of them required chest tube insertion, and six developed ventilator associated pneumonia, while there were no cases of empyema. There was one death due to severe head injury.

Conclusions

Occult hemopneumothorax can be successfully managed without tube thoracostomy in most cases. Patients with a high ISS score, need for mechanical ventilation, and CT-detected blood collection measuring >1.5 cm increased the likelihood of need for tube thoracostomy. The size of the pneumothorax did not appear to be significant in determining the need for tube thoracostomy.

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References

  1. Wilson JM, Boren CH, Peterson SR, Thomas AN. Traumatic hemothorax: is decortication necessary? Thorac Cardiovasc Surg. 1979;77:489–95.

    CAS  Google Scholar 

  2. Watkins JA, Spain DA, Richardson JD, Polk HC Jr. Empyema and restrictive pleural processes after blunt trauma: an under-recognized cause of respiratory failure. Am Surg. 2000;66:210–4.

    PubMed  CAS  Google Scholar 

  3. Deneuville M. Morbidity of percutaneous tube thoracostomy in trauma patients. Eur J Cardiothorac Surg. 2002;22:673–8.

    Google Scholar 

  4. McGonigal MD, Schwab CW, Kauder DR, Miller WT, Grumbach K. Supplemental emergent chest computed tomography in the management of blunt torso trauma. J Trauma. 1990;30:1431–5.

    Article  PubMed  CAS  Google Scholar 

  5. Trupka A, Waydhas C, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L. Value of computed tomographyin the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma. 1997;43:405–12.

    Article  PubMed  CAS  Google Scholar 

  6. De Moya MA, Seaver C, Spaniolas K, Inaba K, Nguyen M, Veltman Y, Shatz D, Alam HB, Pizano L. Occult pneumothorax in trauma patients: development of an objective scoring system. J Trauma. 2007;63:13–7.

    Article  PubMed  Google Scholar 

  7. Eibenberger KL, Dock WI, Ammann ME, Dorffner R, Hörmann MF, Grabenwöger F. Quantification of pleural effusions: sonography versus radiography. Radiology. 1994;191:681–4.

    PubMed  CAS  Google Scholar 

  8. Ruskin JA, Gurney JW, Thorsen MK, Goodman LR. Detection of pleural effusions on supine chest radiographs. Am J Radiol. 1987;148:681–3.

    CAS  Google Scholar 

  9. Muller NL. Imaging of the pleura. Radiology. 1993;186:297–309.

    PubMed  CAS  Google Scholar 

  10. Blackmore CC, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: a chest radiograph prediction rule. Acad Radiol. 1996;3:103.

    Article  PubMed  CAS  Google Scholar 

  11. Collins JD, Burwell D, Furmanski S, Lorber P, Steckel RJ. Minimal detectable pleural effusions: a roentgen pathology model. Radiology. 1972;105:51–3.

    Google Scholar 

  12. Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–40.

    Article  PubMed  CAS  Google Scholar 

  13. Poole GV, Morgan DB, Cranston PE, Muakkassa FF, Griswold JA. Computed tomography in the management of blunt thoracic trauma. J Trauma. 1993;35:296–302.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  15. Enderson BL, Abdalla R, Frame SB, Maull KI. Tube thoracostomy for occult pneumothorax—a prospective randomized study. J Trauma. 1993;35:726–30.

    Article  PubMed  CAS  Google Scholar 

  16. Stafford RE, Linn J, Washington L. Incidence and management of occult hemothoraces. Am J Surg. 2006;192:722–6.

    Article  PubMed  Google Scholar 

  17. 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 

  18. Mahmood I, Abdelrahman H, Al-Hassani A, Nabir S, Sebastian M, Maull K. Clinical management of occult hemothorax: a prospective study of 81 patients. Am J Surg. 2011;201:766–9.

    Article  PubMed  Google Scholar 

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Correspondence to R. Latifi.

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Mahmood, I., Tawfeek, Z., Khoschnau, S. et al. Occult hemopneumothorax following chest trauma does not need a chest tube. Eur J Trauma Emerg Surg 39, 43–46 (2013). https://doi.org/10.1007/s00068-012-0210-1

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  • DOI: https://doi.org/10.1007/s00068-012-0210-1

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