García-Núñez LM, Padilla SR, Lever RCD

Language: Spanish
References: 15
Page: 82-88
PDF size: 62.59 Kb.

ABSTRACT

Thoracic trauma is the cause of death in 25% of patients who sustain major trauma. One of the most frequently found pathological entities in thoracic trauma is the persistence of hematic fluid collections within the thoracic cavity (retained hemothorax). Frequency oscillates between 10-20%. Blood in the pleural space tends to coagulate, with the further development of angiofibroplasia processes and dense intracavitary scarring, which cause important impairment in ventilatory mechanics, gas exchange and secretion clearance. Diagnosis is based on radiology, mainly in computed tomography. There are many options for the treatment of retained hemothorax, which are going from the observation to thoracotomy. Currently, Video Assisted Thoracoscopic Surgery (VATS) is considered by most of authors as the primary procedure of choice in those whose require surgical treatment. Morbidity of retained hemothorax is related to the progress of its natural evolution and to the therapeutical procedures. Mortality is directly related to the magnitude of associated injuries.

REFERENCES

1. Cangir AK, Yuksel C, Mehmet D, Ozgencil E, Genc O et al. Use of intrapleural streptokinase in experimental minimal clotted hemothorax. Eur J Cardiothorac Surg 2005; 27: 667-70.

2. Aguilar MM, Battistella FD, Owings JT, Su T. Posttraumatic empyema. Risk factors analysis. Arch Surg 1997; 132(6): 647-50.

3. Skeete DA, Rutherford EJ, Schlidt SA, Abrams JE et al. Intrapleural tissue plasminogen activator for complicated pleural effusion. J Trauma 2004; 57: 1178-1183.

4. Heniford BT, Carrillo EH, Spain DA, Sosa JL, Fulton RL et al. The role of thoracoscopy in the management of retained thoracic collections after trauma. Ann Thorac Surg 1997; 63: 940-3.

5. Helling TS, Gyles NR III, Eisenstein CL, Soracco CA. Complications following blunt and penetrating injuries in 216 victims of chest trauma requiring tube thoracostomy. J Trauma 1989; 29: 1367-70.

6. Aboholda A, Livingston DH, Donahoo JS, Allen K. Diagnostic and therapeutic video assisted thoracic surgery (VATS) following chest trauma. Eur J Cardiothorac Surg 1997; 12: 356-60.

7. Tomaselli F, Maier A, Renner H, Smolle-Juttner FM. Thoracoscopical water jet lavage in coagulated hemothorax. Eur J Cardiothorac Surg 2003; 23: 424-5.

8. Lowdermilk GA, Naunheim KS. Thoracoscopic evaluation and treatment of thoracic trauma. Surg Clin N Am 2000; 80: 1535-42.

9. Velmahos GC, Demetriades D, Chan L, Tatevossian R et al. Predicting the need of thoracoscopic evacuation of residual traumatic hemothorax: chest radiograph is insufficient. J Trauma 1999; 46: 65-70.

10. Mirvis SE, Tobin KD, Kostrubiak I, Belzberg H. Thoracic CT in detecting occult disease in critically ill patients. AJR 1987; 148: 685-9.

11. Navsaria PH, Vogel R, Nicol AJ. Thoracoscopic evacuation of retained posttraumatic hemothorax. Ann Thorac Surg 2004; 78: 282-6.

12. Jerjes-Sanchez C, Ramirez-Rivera A, Elizalde JJ, Delgado R et al. Intrapleural fibrinolysis with streptokinase as an adjunctive treatment in hemothorax and empyema. A Multi-Center Trial. Chest 1996; 109(6): 1514-9.

13. Landreneau RJ, Keenan RJ, Hazelrigg SR, Mack MJ et al. Thoracoscopy for empyema and hemothorax. Chest 1995; 109: 18-24.

14. Vassiliu P, Velmahos GC, Toutouzas KG. Timing, safety and efficacy of thoracoscopic evacuation of untrained posttraumatic hemothorax. Am Surg 2001; 67(12): 1165-9.

15. Meyer DM, Jessen ME, Wait M, Estrera AS. Early evacuation of traumatic retained hemothoraces using thoracoscopy: A prospective, randomized trial. Ann Thorac Surg 1997; 64: 1396-1400.