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Chapter 21 - Video-Assisted Thoracoscopic Evacuation of Retained Hemothorax

from Section 5 - Chest

Published online by Cambridge University Press:  21 October 2019

By
Aaron Strumwasser  and
Matthew J. Forestiere
Edited by
Demetrios Demetriades ,
Kenji Inaba  and
George Velmahos
Demetrios Demetriades
Affiliation:
University of Southern California
Kenji Inaba
Affiliation:
University of Southern California
George Velmahos
Affiliation:
Massachusetts General Hospital, Boston
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Summary

  • The majority of traumatic hemothoraces can be managed successfully with a chest tube placement.

  • Retained hemothorax is defined as residual pleural blood >300–500 mL after initial thoracostomy tube evacuation.

  • The gold standard for diagnosing retained hemothorax is a noncontrast CT scan of the chest. A chest X-ray is not reliable in the accurate diagnosis of retained hemothorax.

  • VATS is usually contraindicated in patients with previous thoracic operations and in patients with respiratory failure or significant contralateral lung injury, such as contusion, atelectasis, or pneumonia, because single-lung ventilation may not be tolerated.

  • Ideally, VATS should be done within the first 3–5 days. Early VATS (within 72 hours of admission) for evacuation of retained hemothorax reduces hospital length of stay, number of procedures, and cost. VATS is more difficult and less effective if performed more than 7–10 days after the injury, due to clot organization and dense adhesions.

Type
Chapter
Information
Atlas of Surgical Techniques in Trauma , pp. 164 - 170
Publisher: Cambridge University Press
Print publication year: 2020

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