title: Indications for transcatheter arterial embolization in persistent hemothorax caused by blunt trauma.
abstract: BACKGROUND
  To confirm the usefulness of contrast-enhanced computed tomography (CECT) and the efficacy of transcatheter arterial embolization (TAE) in patients, who undergo tube thoracostomy for hemothorax secondary to blunt chest trauma.
  
  
  METHODS
  CECT was performed at admission in patients, who suffered blunt chest trauma but did not require an emergent thoracotomy. Pulmonary injuries with intrapulmonary hematomas or traumatic pneumatoceles or both on computed tomography images were diagnosed as pulmonary lacerations (PL). The size of the pulmonary injuries with the PL was measured as percent volume (volume of the PL/volume of the lung). Rib fracture displacement was measured on computed tomography images and expressed as parallel and transverse displacement of the fractured ribs (PD and TD, respectively). Patients with an injury to a thoracic great vessel (e.g., aortic injury) were excluded.
  
  
  RESULTS
  CECT of the chest was performed on 154 of 976 consecutive patients with blunt torso trauma. Thirty-four patients have PL without a great vessel injury. Tube thoracostomy was performed at 38 sites in 29 patients. After the initial bloody drainage, the mean drainage during the first hour was 81.2 mL/h +/- 137 mL/h. The mean percent volume of the PL was 29.0% +/- 15.4%. The mean PD was 12.2 mm +/- 10.4 mm. The PD and the TD correlated with the hourly drainage (p = 0.001, p < 0.001, respectively). No correlation was found between the percent volume of PL and hourly drainage (p = 0.11). Of the 38 thoracostomy sites, 6 had a blood loss of > or =200 mL/h. Contrast extravasation on CECT was observed in five of these six sites, and angiography was performed. All five sites had contrast extravasation from an intercostal artery, and TAE was successfully performed.
  
  
  CONCLUSIONS
  Intercostal arterial bleeding should be suspected in patients with persistent hemothorax > or =200 mL/h and large displacement of a fractured rib. In such cases, CECT should be performed and TAE is indicated if contrast extravasation is observed.
authors.affiliation: Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Saitama, Japan. boeihagi@ndmc.ac.jp
authors.forename: Akiyoshi
authors.initials: A
authors.lastname: Hagiwara
authors.forename: Youichi
authors.initials: Y
authors.lastname: Yanagawa
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kaneko
authors.forename: Akira
authors.initials: A
authors.lastname: Takasu
authors.forename: Kousuke
authors.initials: K
authors.lastname: Hatanaka
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Okada
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002406:Catheterization, Peripheral; D015331:Cohort Studies; D004621:Embolization, Therapeutic; D005260:Female; D006491:Hemothorax / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D012253:Rib Fractures / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D013907:Thoracostomy; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000628:therapy