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  • Title: Clinical management of occult hemothorax: a prospective study of 81 patients.
    Author: Mahmood I, Abdelrahman H, Al-Hassani A, Nabir S, Sebastian M, Maull K.
    Journal: Am J Surg; 2011 Jun; 201(6):766-9. PubMed ID: 21741510.
    Abstract:
    BACKGROUND: Intrapleural blood detected by computed tomography scan, but not evident on plain chest radiograph, defines occult hemothorax. This study determined the role for tube thoracostomy. METHODS: Hemothorax was quantified on computed tomography by measuring the deepest lamellar fluid stripe at the most dependent portion. Data were collected prospectively on demographics, injury mechanism/severity, chest injuries, mechanical ventilation, hospital length of stay, complications, and outcome. Indications for tube thoracostomy were recorded. RESULTS: Tube thoracostomy was avoided in 67 patients (83%). Indications for chest tube placement included progression of hemothorax (8), desaturation (4), and delayed hemothorax (2). Patients with intrapleural fluid thickness greater than 1.5 cm were 4 times more likely to require tube thoracostomy. CONCLUSIONS: Occult hemothorax can be managed successfully without tube thoracostomy in most cases. Mechanical ventilation is not an indication for chest tube placement. Accompanying occult pneumothorax may be expected in 50% of cases, but did not affect clinical management.
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