ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Management of hemothorax: an evaluation of 192 cases
Ekrem Şentürk1, Ertuğrul Yoldaş2, Yeşim Doğan2
1Adnan Menderes Üniversitesi Tıp Fakültesi Göğüs Cerrahisi Anabilim Dalı, Aydın
2Denizli Devlet Hastanesi Göğüs Cerrahisi Kliniği, Denizli
Background: We evaluated treatment approaches to and follow-up findings of patients with hemothorax of various etiologies.

Methods: We retrospectively analyzed 192 patients (153 males, 39 females; mean age 49±14 years) who received treatment for hemothorax between 2006 and 2008.

Results: The most common etiology of hemothorax was trauma (n=166, 86.5%). Hemothorax was due to primary or metastatic lung malignancies in 17 patients (8.9%), to iatrogenic causes in four patients (2.1%), and to complications caused by tuberculosis in two patients (1%), pulmonary hydatid cyst in one patient, and lung perforation from bullous disease in one patient. The most common traumatic cause was traffic accidents (50.6%), followed by penetrating injuries (14.5%, falls (12.7%), and animal-induced injuries (7.2%). Traumatic hemothorax was associated with accompanying injuries in 48.8%, the most common being abdominal injuries in 18.7%. Thoracentesis was performed in five patients (2.6%), two with tuberculosis, two with lung malignancies, and one with iatrogenic hemothorax. Tube thoracostomy was effective in 163 patients (84.9%). Thoracotomy was performed in 24 patients (12.5), of which six required an emergency thoracotomy. During thoracotomy, parenchymal laceration was observed in nine patients, intercostal vascular injury in six patients, and diaphragmatic injury in three patients. The conservative approach was sufficient to resolve hemothorax in 163 patients (84.9%). The mean hospital stay was 9.4 days. Mortality occurred in seven patients (3.7%).

Conclusion: Hemothorax is an emergency situation that requires rapid diagnosis. Identification of its cause facilitates the diagnosis. The first therapeutic attempt must be immediate tube thoracostomy. In cases in which conservative treatment fails, thoracotomy and video-assisted thoracoscopic surgery are warranted.

Keywords : Chest tubes; drainage/methods; hemothorax/etiology/ surgery; thoracic injuries/therapy; thoracostomy; thoracotomy
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