#HEMOTHORAX LUNG SOUNDS FREE#

Other findings may reflect the underlying disease process (ie gallop, murmur, fever, trauma). It may be possible to percuss a ventral dullness. Occasionally, lung sounds may appear normal.

Physical examination findings may include respiratory distress and muffled heart/lung sounds. It is important to recall that pleural effusion is a sign rather than a specific diagnosis. Clinical signs of pleural space disease include tachypnea or difficulty breathing. A very small amount of fluid (undetectable on radiographs or ultrasound) may be present within the thoracic cavity.

#HEMOTHORAX LUNG SOUNDS FREE#

Normally there is no soft tissue or free air present in this space. Instillation of streptokinase for liquidification has been suggested but has not found wide application.The pleural space is defined as the area between the lungs and the chest wall. Otherwise, evacuation of the retained clot can be technically difficult. It is recommended that VATS should take place at an early stage preferably after the fifth post injury day. If a retained hemothorax is not drained, there is a possibility of development of an empyema. If there is retained hemothorax that cannot be drained with a further insertion with an intercostal drain, a video-assisted thoracoscopy (VATS) should be considered. A chest X-ray at those cases is imperative. It is important to make sure that there is no retained hemothorax after the drains stop working or after they get removed. Insertion of another drain in the presence of retained hemothorax is acceptable. In contradiction, this is not always happening with a hemothorax, which is usually retained at the lower posterior part of the pleural cavity, where due to gravity, it is mostly accumulated. Taking into consideration the fact that many times hemothorax coincides with pneumothorax, this is the ideal positioning of the intercostal drain, as the pneumothorax will, in any case, be drained from the pleural cavity irrespective of the positioning of the intercostal drain as the air will be pumped out the pleural cavity by the lung expansion during inspiration. 7.3b improper positioning) so that the drainage of the hemothorax would be effective irrespective if the patient is sitting up or lies flat in his bed. The treatment is the insertion of an intercostal drain, which should be directed downwards and backwards (Fig. The supine chest X-ray will show a homogeneous haziness of the hemithorax that is caused by the creation of a film of blood of variable “thickness” (relevant to the volume of the blood retained) that lies at the posterior aspect of the affected pleural cavity.

An erect chest X-ray will show obliteration of the costophrenic angle, formed by the accumulation of blood (if it is less than 500 cc, it could well not show in the erect X-ray), or by an air-fluid level in the presence of a concomitant pneumothorax. This may require an operative management of the pneumothorax.Ĭlinical examination will reveal decreased breath sound on auscultation, and dullness on percussion particularly on the examination of the posterior lower hemithorax, with the patient in the sitting-up position. “Bubbling” at the intercostal drain collecting canister is an indication of air leak related to bronchial injury (Fig. On inspiration, the dressing occludes the wound preventing air from entering, while on expiration, the nontaped side of the dressing allows air to escape from the pleural cavity. In the presence of an open pneumothorax, secondary to a large defect of the chest wall, this defect must be managed by the application of a “three side dressing.” This should be square shaped, sterile occlusive dressing, large enough to overlap the edges of the wound, and should be taped on the three of its four sides in order to provide a flutter-type valve effect. This should be followed by the insertion of an intercostal drain and the simultaneous occlusion on the thoracic wall opening usually with stitches. The treatment is rapid insertion of a large caliber needle into the second intercostal space in the midclavicular line of the affected side.

Hemothorax lung sounds