title: Clinical management of occult hemothorax: a prospective study of 81 patients.
abstract: BACKGROUND
  Intrapleural blood detected by computed tomography scan, but not evident on plain chest radiograph, defines occult hemothorax. This study determined the role for tube thoracostomy.
  
  
  METHODS
  Hemothorax was quantified on computed tomography by measuring the deepest lamellar fluid stripe at the most dependent portion. Data were collected prospectively on demographics, injury mechanism/severity, chest injuries, mechanical ventilation, hospital length of stay, complications, and outcome. Indications for tube thoracostomy were recorded.
  
  
  RESULTS
  Tube thoracostomy was avoided in 67 patients (83%). Indications for chest tube placement included progression of hemothorax (8), desaturation (4), and delayed hemothorax (2). Patients with intrapleural fluid thickness greater than 1.5 cm were 4 times more likely to require tube thoracostomy.
  
  
  CONCLUSIONS
  Occult hemothorax can be managed successfully without tube thoracostomy in most cases. Mechanical ventilation is not an indication for chest tube placement. Accompanying occult pneumothorax may be expected in 50% of cases, but did not affect clinical management.
authors: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors: Ismail
authors: I
authors: Mahmood
authors: Husham
authors: H
authors: Abdelrahman
authors: Ammar
authors: A
authors: Al-Hassani
authors: Syed
authors: S
authors: Nabir
authors: Mark
authors: M
authors: Sebastian
authors: Kimball
authors: K
authors: Maull
mesh_terms: D000328:Adult; D015505:Chest Tubes; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006491:Hemothorax / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011859:Radiography; D013898:Thoracic Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D013907:Thoracostomy / Q000295:instrumentation*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging