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__NOTOC__ | __NOTOC__ | ||
{{Hemothorax}} | {{Hemothorax}} | ||
{{CMG}}; {{AE}} [[User:Irfan Dotani|Irfan Dotani]] | {{CMG}}; {{AE}} [[User:Irfan Dotani|Irfan Dotani]] {{JE}} | ||
==Overview== | ==Overview== | ||
The mainstay of medical therapy for hemothorax is fluid resuscitation and blood transfusion. All patients, regardless of causes, require attention for fluid resuscitation and blood transfusion. Prophylactic use of [[Antibiotic|antibiotics]] following haemothorax reduces the rate of infectious complications such as [[pneumonia]] and [[Pleural empyema|empyema]] during at least 24 hours after the start of chest tube drainage. Antibiotic treatment should be directed to [[Staphylococcus aureus]] and [[Streptococcus|Streptococcus species]] and the use of [[Cephalosporins|first generation cephalosporins]] during the first 24 hours in patients treated with chest tube drainage is recommended. Intrapleural [[Fibrinolytic agent|fibrinolytic]] therapy (IPFT) has been advocated as an alternative to evacuating residual blood clots and break down adhesions in low-resource settings where the relatively costly and sophisticated technique of VATS may not be available, feasible or applicable. Several studies report on IPFT with [[streptokinase]], [[urokinase]] or [[tissue plasminogen activator]] (TPA). Duration of treatment with IPFT can vary between 2 and 9 days for streptokinase and 2–15 days for urokinase.<ref name="pmid25922734">{{cite journal |vauthors=Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR |title=Etiology and management of spontaneous haemothorax |journal=J Thorac Dis |volume=7 |issue=3 |pages=520–6 |date=March 2015 |pmid=25922734 |pmc=4387396 |doi=10.3978/j.issn.2072-1439.2014.12.50 |url=}}</ref><ref name="pmid25638240">{{cite journal |vauthors=Ho C, Ismail AR |title=Spontaneous haemothorax: a case report |journal=Med. J. Malaysia |volume=69 |issue=5 |pages=234–5 |date=October 2014 |pmid=25638240 |doi= |url=}}</ref> <ref name="pmid21740393">{{cite journal |vauthors=Rad MG, Mahmodlou R, Mohammadi A, Mladkova N, Noorozinia F |title=Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report |journal=Tuberk Toraks |volume=59 |issue=2 |pages=168–72 |date=2011 |pmid=21740393 |doi= |url=}}</ref><ref name="pmid25813733">{{cite journal |vauthors=Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N |title=VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax |journal=Injury |volume=46 |issue=9 |pages=1749–52 |date=September 2015 |pmid=25813733 |doi=10.1016/j.injury.2015.02.028 |url=}}</ref><ref name="pmid20817498">{{cite journal |vauthors=Boersma WG, Stigt JA, Smit HJ |title=Treatment of haemothorax |journal=Respir Med |volume=104 |issue=11 |pages=1583–7 |date=November 2010 |pmid=20817498 |doi=10.1016/j.rmed.2010.08.006 |url=}}</ref><ref name="pmid26197910">{{cite journal |vauthors=Miyahara S, Iwasaki A |title=[Diagnosis and Treatment of Hemothorax] |language=Japanese |journal=Kyobu Geka |volume=68 |issue=8 |pages=650–3 |date=July 2015 |pmid=26197910 |doi= |url=}}</ref><ref name="pmid9262119">{{cite journal |vauthors=Yeam I, Sassoon C |title=Hemothorax and chylothorax |journal=Curr Opin Pulm Med |volume=3 |issue=4 |pages=310–4 |date=July 1997 |pmid=9262119 |doi= |url=}}</ref><ref name="pmid18716687">{{cite journal |vauthors=Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ |title=Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury |journal=Can. Respir. J. |volume=15 |issue=5 |pages=255–8 |date=2008 |pmid=18716687 |pmc=2679547 |doi=10.1155/2008/918951 |url=}}</ref><ref name="pmid24698396">{{cite journal |vauthors=Villena Garrido V, Cases Viedma E, Fernández Villar A, de Pablo Gafas A, Pérez Rodríguez E, Porcel Pérez JM, Rodríguez Panadero F, Ruiz Martínez C, Salvatierra Velázquez A, Valdés Cuadrado L |title=Recommendations of diagnosis and treatment of pleural effusion. Update |journal=Arch. Bronconeumol. |volume=50 |issue=6 |pages=235–49 |date=June 2014 |pmid=24698396 |doi=10.1016/j.arbres.2014.01.016 |url=}}</ref><ref name="pmid17483994">{{cite journal |vauthors=Morales Uribe CH, Villegas Lanau MI, Petro Sánchez RD |title=Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax |journal=Surg Endosc |volume=22 |issue=1 |pages=91–5 |date=January 2008 |pmid=17483994 |doi=10.1007/s00464-007-9378-6 |url=}}</ref> | The mainstay of medical therapy for hemothorax is [[Fluid replacement|fluid resuscitation]] and [[blood transfusion]]. All patients, regardless of causes, require attention for [[Fluid replacement|fluid resuscitation]] and [[blood transfusion]]. Prophylactic use of [[Antibiotic|antibiotics]] following haemothorax reduces the rate of [[infection|infectious]] complications such as [[pneumonia]] and [[Pleural empyema|empyema]] during at least 24 hours after the start of [[chest tube]] drainage. [[Antibiotic]] treatment should be directed to [[Staphylococcus aureus]] and [[Streptococcus|Streptococcus species]] and the use of [[Cephalosporins|first generation cephalosporins]] during the first 24 hours in patients treated with [[chest tube]] drainage is recommended. Intrapleural [[Fibrinolytic agent|fibrinolytic]] therapy (IPFT) has been advocated as an alternative to evacuating residual [[Thrombus|blood clots]] and break down adhesions in low-resource settings where the relatively costly and sophisticated technique of [[Thoracoscopy|VATS]] may not be available, feasible or applicable. Several studies report on IPFT with [[streptokinase]], [[urokinase]] or [[tissue plasminogen activator]] (TPA). Duration of treatment with IPFT can vary between 2 and 9 days for [[streptokinase]] and 2–15 days for [[urokinase]].<ref name="pmid25922734">{{cite journal |vauthors=Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR |title=Etiology and management of spontaneous haemothorax |journal=J Thorac Dis |volume=7 |issue=3 |pages=520–6 |date=March 2015 |pmid=25922734 |pmc=4387396 |doi=10.3978/j.issn.2072-1439.2014.12.50 |url=}}</ref><ref name="pmid25638240">{{cite journal |vauthors=Ho C, Ismail AR |title=Spontaneous haemothorax: a case report |journal=Med. J. Malaysia |volume=69 |issue=5 |pages=234–5 |date=October 2014 |pmid=25638240 |doi= |url=}}</ref> <ref name="pmid21740393">{{cite journal |vauthors=Rad MG, Mahmodlou R, Mohammadi A, Mladkova N, Noorozinia F |title=Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report |journal=Tuberk Toraks |volume=59 |issue=2 |pages=168–72 |date=2011 |pmid=21740393 |doi= |url=}}</ref><ref name="pmid25813733">{{cite journal |vauthors=Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N |title=VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax |journal=Injury |volume=46 |issue=9 |pages=1749–52 |date=September 2015 |pmid=25813733 |doi=10.1016/j.injury.2015.02.028 |url=}}</ref><ref name="pmid20817498">{{cite journal |vauthors=Boersma WG, Stigt JA, Smit HJ |title=Treatment of haemothorax |journal=Respir Med |volume=104 |issue=11 |pages=1583–7 |date=November 2010 |pmid=20817498 |doi=10.1016/j.rmed.2010.08.006 |url=}}</ref><ref name="pmid26197910">{{cite journal |vauthors=Miyahara S, Iwasaki A |title=[Diagnosis and Treatment of Hemothorax] |language=Japanese |journal=Kyobu Geka |volume=68 |issue=8 |pages=650–3 |date=July 2015 |pmid=26197910 |doi= |url=}}</ref><ref name="pmid9262119">{{cite journal |vauthors=Yeam I, Sassoon C |title=Hemothorax and chylothorax |journal=Curr Opin Pulm Med |volume=3 |issue=4 |pages=310–4 |date=July 1997 |pmid=9262119 |doi= |url=}}</ref><ref name="pmid18716687">{{cite journal |vauthors=Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ |title=Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury |journal=Can. Respir. J. |volume=15 |issue=5 |pages=255–8 |date=2008 |pmid=18716687 |pmc=2679547 |doi=10.1155/2008/918951 |url=}}</ref><ref name="pmid24698396">{{cite journal |vauthors=Villena Garrido V, Cases Viedma E, Fernández Villar A, de Pablo Gafas A, Pérez Rodríguez E, Porcel Pérez JM, Rodríguez Panadero F, Ruiz Martínez C, Salvatierra Velázquez A, Valdés Cuadrado L |title=Recommendations of diagnosis and treatment of pleural effusion. Update |journal=Arch. Bronconeumol. |volume=50 |issue=6 |pages=235–49 |date=June 2014 |pmid=24698396 |doi=10.1016/j.arbres.2014.01.016 |url=}}</ref><ref name="pmid17483994">{{cite journal |vauthors=Morales Uribe CH, Villegas Lanau MI, Petro Sánchez RD |title=Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax |journal=Surg Endosc |volume=22 |issue=1 |pages=91–5 |date=January 2008 |pmid=17483994 |doi=10.1007/s00464-007-9378-6 |url=}}</ref> | ||
==Medical Therapy== | ==Medical Therapy== | ||
<ref name="pmid25922734">{{cite journal |vauthors=Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR |title=Etiology and management of spontaneous haemothorax |journal=J Thorac Dis |volume=7 |issue=3 |pages=520–6 |date=March 2015 |pmid=25922734 |pmc=4387396 |doi=10.3978/j.issn.2072-1439.2014.12.50 |url=}}</ref><ref name="pmid25638240">{{cite journal |vauthors=Ho C, Ismail AR |title=Spontaneous haemothorax: a case report |journal=Med. J. Malaysia |volume=69 |issue=5 |pages=234–5 |date=October 2014 |pmid=25638240 |doi= |url=}}</ref> <ref name="pmid21740393">{{cite journal |vauthors=Rad MG, Mahmodlou R, Mohammadi A, Mladkova N, Noorozinia F |title=Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report |journal=Tuberk Toraks |volume=59 |issue=2 |pages=168–72 |date=2011 |pmid=21740393 |doi= |url=}}</ref><ref name="pmid25813733">{{cite journal |vauthors=Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N |title=VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax |journal=Injury |volume=46 |issue=9 |pages=1749–52 |date=September 2015 |pmid=25813733 |doi=10.1016/j.injury.2015.02.028 |url=}}</ref><ref name="pmid20817498">{{cite journal |vauthors=Boersma WG, Stigt JA, Smit HJ |title=Treatment of haemothorax |journal=Respir Med |volume=104 |issue=11 |pages=1583–7 |date=November 2010 |pmid=20817498 |doi=10.1016/j.rmed.2010.08.006 |url=}}</ref><ref name="pmid26197910">{{cite journal |vauthors=Miyahara S, Iwasaki A |title=[Diagnosis and Treatment of Hemothorax] |language=Japanese |journal=Kyobu Geka |volume=68 |issue=8 |pages=650–3 |date=July 2015 |pmid=26197910 |doi= |url=}}</ref><ref name="pmid9262119">{{cite journal |vauthors=Yeam I, Sassoon C |title=Hemothorax and chylothorax |journal=Curr Opin Pulm Med |volume=3 |issue=4 |pages=310–4 |date=July 1997 |pmid=9262119 |doi= |url=}}</ref><ref name="pmid18716687">{{cite journal |vauthors=Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ |title=Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury |journal=Can. Respir. J. |volume=15 |issue=5 |pages=255–8 |date=2008 |pmid=18716687 |pmc=2679547 |doi=10.1155/2008/918951 |url=}}</ref><ref name="pmid24698396">{{cite journal |vauthors=Villena Garrido V, Cases Viedma E, Fernández Villar A, de Pablo Gafas A, Pérez Rodríguez E, Porcel Pérez JM, Rodríguez Panadero F, Ruiz Martínez C, Salvatierra Velázquez A, Valdés Cuadrado L |title=Recommendations of diagnosis and treatment of pleural effusion. Update |journal=Arch. Bronconeumol. |volume=50 |issue=6 |pages=235–49 |date=June 2014 |pmid=24698396 |doi=10.1016/j.arbres.2014.01.016 |url=}}</ref><ref name="pmid17483994">{{cite journal |vauthors=Morales Uribe CH, Villegas Lanau MI, Petro Sánchez RD |title=Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax |journal=Surg Endosc |volume=22 |issue=1 |pages=91–5 |date=January 2008 |pmid=17483994 |doi=10.1007/s00464-007-9378-6 |url=}}</ref> | <ref name="pmid25922734">{{cite journal |vauthors=Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR |title=Etiology and management of spontaneous haemothorax |journal=J Thorac Dis |volume=7 |issue=3 |pages=520–6 |date=March 2015 |pmid=25922734 |pmc=4387396 |doi=10.3978/j.issn.2072-1439.2014.12.50 |url=}}</ref><ref name="pmid25638240">{{cite journal |vauthors=Ho C, Ismail AR |title=Spontaneous haemothorax: a case report |journal=Med. J. Malaysia |volume=69 |issue=5 |pages=234–5 |date=October 2014 |pmid=25638240 |doi= |url=}}</ref> <ref name="pmid21740393">{{cite journal |vauthors=Rad MG, Mahmodlou R, Mohammadi A, Mladkova N, Noorozinia F |title=Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report |journal=Tuberk Toraks |volume=59 |issue=2 |pages=168–72 |date=2011 |pmid=21740393 |doi= |url=}}</ref><ref name="pmid25813733">{{cite journal |vauthors=Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N |title=VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax |journal=Injury |volume=46 |issue=9 |pages=1749–52 |date=September 2015 |pmid=25813733 |doi=10.1016/j.injury.2015.02.028 |url=}}</ref><ref name="pmid20817498">{{cite journal |vauthors=Boersma WG, Stigt JA, Smit HJ |title=Treatment of haemothorax |journal=Respir Med |volume=104 |issue=11 |pages=1583–7 |date=November 2010 |pmid=20817498 |doi=10.1016/j.rmed.2010.08.006 |url=}}</ref><ref name="pmid26197910">{{cite journal |vauthors=Miyahara S, Iwasaki A |title=[Diagnosis and Treatment of Hemothorax] |language=Japanese |journal=Kyobu Geka |volume=68 |issue=8 |pages=650–3 |date=July 2015 |pmid=26197910 |doi= |url=}}</ref><ref name="pmid9262119">{{cite journal |vauthors=Yeam I, Sassoon C |title=Hemothorax and chylothorax |journal=Curr Opin Pulm Med |volume=3 |issue=4 |pages=310–4 |date=July 1997 |pmid=9262119 |doi= |url=}}</ref><ref name="pmid18716687">{{cite journal |vauthors=Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ |title=Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury |journal=Can. Respir. J. |volume=15 |issue=5 |pages=255–8 |date=2008 |pmid=18716687 |pmc=2679547 |doi=10.1155/2008/918951 |url=}}</ref><ref name="pmid24698396">{{cite journal |vauthors=Villena Garrido V, Cases Viedma E, Fernández Villar A, de Pablo Gafas A, Pérez Rodríguez E, Porcel Pérez JM, Rodríguez Panadero F, Ruiz Martínez C, Salvatierra Velázquez A, Valdés Cuadrado L |title=Recommendations of diagnosis and treatment of pleural effusion. Update |journal=Arch. Bronconeumol. |volume=50 |issue=6 |pages=235–49 |date=June 2014 |pmid=24698396 |doi=10.1016/j.arbres.2014.01.016 |url=}}</ref><ref name="pmid17483994">{{cite journal |vauthors=Morales Uribe CH, Villegas Lanau MI, Petro Sánchez RD |title=Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax |journal=Surg Endosc |volume=22 |issue=1 |pages=91–5 |date=January 2008 |pmid=17483994 |doi=10.1007/s00464-007-9378-6 |url=}}</ref> | ||
* Fluid resuscitation and blood transfusion | * [[Fluid replacement|Fluid resuscitation]] and [[blood transfusion]] | ||
* Prophylactic use of [[Antibiotic|antibiotics]] | * Prophylactic use of [[Antibiotic|antibiotics]] | ||
* Intrapleural [[Fibrinolytic agent|fibrinolytic]] therapy (IPFT) | * Intrapleural [[Fibrinolytic agent|fibrinolytic]] therapy (IPFT) | ||
==References== | ==References== | ||
Latest revision as of 17:40, 27 August 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Irfan Dotani Joanna Ekabua, M.D. [2]
Overview
The mainstay of medical therapy for hemothorax is fluid resuscitation and blood transfusion. All patients, regardless of causes, require attention for fluid resuscitation and blood transfusion. Prophylactic use of antibiotics following haemothorax reduces the rate of infectious complications such as pneumonia and empyema during at least 24 hours after the start of chest tube drainage. Antibiotic treatment should be directed to Staphylococcus aureus and Streptococcus species and the use of first generation cephalosporins during the first 24 hours in patients treated with chest tube drainage is recommended. Intrapleural fibrinolytic therapy (IPFT) has been advocated as an alternative to evacuating residual blood clots and break down adhesions in low-resource settings where the relatively costly and sophisticated technique of VATS may not be available, feasible or applicable. Several studies report on IPFT with streptokinase, urokinase or tissue plasminogen activator (TPA). Duration of treatment with IPFT can vary between 2 and 9 days for streptokinase and 2–15 days for urokinase.[1][2] [3][4][5][6][7][8][9][10]
Medical Therapy
[1][2] [3][4][5][6][7][8][9][10]
- Fluid resuscitation and blood transfusion
- Prophylactic use of antibiotics
- Intrapleural fibrinolytic therapy (IPFT)
References
- ↑ 1.0 1.1 Patrini D, Panagiotopoulos N, Pararajasingham J, Gvinianidze L, Iqbal Y, Lawrence DR (March 2015). "Etiology and management of spontaneous haemothorax". J Thorac Dis. 7 (3): 520–6. doi:10.3978/j.issn.2072-1439.2014.12.50. PMC 4387396. PMID 25922734.
- ↑ 2.0 2.1 Ho C, Ismail AR (October 2014). "Spontaneous haemothorax: a case report". Med. J. Malaysia. 69 (5): 234–5. PMID 25638240.
- ↑ 3.0 3.1 Rad MG, Mahmodlou R, Mohammadi A, Mladkova N, Noorozinia F (2011). "Spontaneous massive hemothorax secondary to chest wall chondrosarcoma: a case report". Tuberk Toraks. 59 (2): 168–72. PMID 21740393.
- ↑ 4.0 4.1 Kumar S, Rathi V, Rattan A, Chaudhary S, Agarwal N (September 2015). "VATS versus intrapleural streptokinase: A prospective, randomized, controlled clinical trial for optimum treatment of post-traumatic Residual Hemothorax". Injury. 46 (9): 1749–52. doi:10.1016/j.injury.2015.02.028. PMID 25813733.
- ↑ 5.0 5.1 Boersma WG, Stigt JA, Smit HJ (November 2010). "Treatment of haemothorax". Respir Med. 104 (11): 1583–7. doi:10.1016/j.rmed.2010.08.006. PMID 20817498.
- ↑ 6.0 6.1 Miyahara S, Iwasaki A (July 2015). "[Diagnosis and Treatment of Hemothorax]". Kyobu Geka (in Japanese). 68 (8): 650–3. PMID 26197910.
- ↑ 7.0 7.1 Yeam I, Sassoon C (July 1997). "Hemothorax and chylothorax". Curr Opin Pulm Med. 3 (4): 310–4. PMID 9262119.
- ↑ 8.0 8.1 Karmy-Jones R, Holevar M, Sullivan RJ, Fleisig A, Jurkovich GJ (2008). "Residual hemothorax after chest tube placement correlates with increased risk of empyema following traumatic injury". Can. Respir. J. 15 (5): 255–8. doi:10.1155/2008/918951. PMC 2679547. PMID 18716687.
- ↑ 9.0 9.1 Villena Garrido V, Cases Viedma E, Fernández Villar A, de Pablo Gafas A, Pérez Rodríguez E, Porcel Pérez JM, Rodríguez Panadero F, Ruiz Martínez C, Salvatierra Velázquez A, Valdés Cuadrado L (June 2014). "Recommendations of diagnosis and treatment of pleural effusion. Update". Arch. Bronconeumol. 50 (6): 235–49. doi:10.1016/j.arbres.2014.01.016. PMID 24698396.
- ↑ 10.0 10.1 Morales Uribe CH, Villegas Lanau MI, Petro Sánchez RD (January 2008). "Best timing for thoracoscopic evacuation of retained post-traumatic hemothorax". Surg Endosc. 22 (1): 91–5. doi:10.1007/s00464-007-9378-6. PMID 17483994.