title: Occult hemopneumothorax following chest trauma does not need a chest tube.
abstract: BACKGROUND
  The increasing use of thoracic computed tomography (CT) in trauma patients has led to the recognition of intrapleural blood and air that are not initially evident on admission plain chest X-ray, defining the presence of occult hemopneumothorax. The clinical significance of occult hemopneumothorax, specifically the role of the tube thoracostomy, is not clearly defined.
  
  
  OBJECTIVE
  To identify those patients with occult hemopneumothorax who can be safely managed without chest tube insertion.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  During the recent 24 month period ending July 2010, comprehensive data on trauma patients with occult hemopneumothorax were recorded to determine whether tube thoracostomy was needed and, if not, to define the consequences of nondrainage. Pneumothorax and hemothorax were quantified by computed tomography (CT) measurement. Data included demographics, injury mechanism and severity, chest injuries, need for mechanical ventilation, indications for tube thoracostomy, hospital length of stay, complications and outcome.
  
  
  RESULTS
  There were 73 patients with hemopenumothorax identified on CT scan in our trauma registry. Tube thoracostomy was successfully avoided in 60 patients (83 %). Indications for chest tube placement in 13 (17 %) of patients included X-ray evidence of hemothorax progression (10), respiratory compromise with oxygen desaturation (2). Mechanical ventilation was required in 19 patients, five of them required chest tube insertion, and six developed ventilator associated pneumonia, while there were no cases of empyema. There was one death due to severe head injury.
  
  
  CONCLUSIONS
  Occult hemopneumothorax can be successfully managed without tube thoracostomy in most cases. Patients with a high ISS score, need for mechanical ventilation, and CT-detected blood collection measuring >1.5 cm increased the likelihood of need for tube thoracostomy. The size of the pneumothorax did not appear to be significant in determining the need for tube thoracostomy.
authors.affiliation: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: I
authors.initials: I
authors.lastname: Mahmood
authors.affiliation: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: Z
authors.initials: Z
authors.lastname: Tawfeek
authors.affiliation: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: S
authors.initials: S
authors.lastname: Khoschnau
authors.affiliation: Department of Radiology, Hamad General Hospital, Doha, Qatar.
authors.forename: S
authors.initials: S
authors.lastname: Nabir
authors.affiliation: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: A
authors.initials: A
authors.lastname: Almadani
authors.affiliation: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: H
authors.initials: H
authors.lastname: Al Thani
authors.affiliation: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar.
authors.forename: K
authors.initials: K
authors.lastname: Maull
authors.affiliation: Section of Trauma Surgery, Department of Surgery, Hamad General Hospital, Doha, Qatar. Rifat.Latifi@gmail.com.
authors.forename: R
authors.initials: R
authors.lastname: Latifi
keywords: Chest trauma; Chest tube; Occult hemothorax; Occult pneumothorax
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