The role of MDCT in the management of hemothorax in traumatized patients

Abstract

PURPOSE: In polytraumatized patients with active bleeding, the improvement of survival depends on control/early stoppage of bleeding. The purpose of our study was to define the role of MDCT in patients with hemothorax.

MATERIALS AND METHODS: From January 2008 to December 2013, we performed thoraco-abdominal CT to 1352 patients with polytrauma or thoracic blunt trauma. We retrospectively reviewed CT of 93 patients (mean age 65 years) where MDCT showed hemothorax. Basing on CT findings, 12 patients have been treated with interventional radiology, 78 patients with surgical procedures (drainage tube, VATS, thoracotomy).

RESULTS: CT showed rib fractures in 85 patients; an active bleeding in arterial phase, with associated hematic pleural effusion in 12 patients;2 pseudoaneurysm in 2 patients. Two patients with flail chest showed bleeding a few days after traumatic event. Nine patients underwent to percutaneous treatment with technical success in 9/10 (90%).

CONCLUSIONS: MDCT demonstrates high value in the management of patients with thoracic blunt trauma, identifying and classifying the severity of injuries. It shows high accuracy in the diagnosis of active bleeding and precludes the occurrence of complications. In the detection of active bleeding CT allows correct selection and safe treatment planning. In polytraumatized patients the selective arteriography and transcatheter embolization provide a viable diagnostic and therapeutic alternative in the management of bleeding from arterial lesions.