From the Research
Extrapleural hematomas should be managed based on their size, symptoms, and hemodynamic impact on the patient, with a preference for conservative management for small, asymptomatic cases and more aggressive intervention for larger or symptomatic cases, as supported by the most recent study 1. The management of extrapleural hematomas involves a range of approaches, from conservative monitoring to surgical intervention. Key considerations include:
- Size and symptoms of the hematoma
- Hemodynamic impact on the patient
- Presence of active bleeding or expansion
- Underlying cause, such as trauma, iatrogenic injury, or coagulopathy Small, asymptomatic extrapleural hematomas can often be managed conservatively with:
- Close monitoring
- Pain control using NSAIDs like ibuprofen (400-600mg every 6 hours) or acetaminophen (1000mg every 6 hours)
- Serial imaging to ensure resolution However, larger hematomas causing significant symptoms, respiratory compromise, or hemodynamic instability require more aggressive intervention, such as:
- Surgical evacuation through video-assisted thoracoscopic surgery (VATS) or thoracotomy
- Angiographic embolization to control the hemorrhage source in cases with active bleeding It is essential to correct any underlying coagulopathy with appropriate blood products and discontinue anticoagulant medications if possible, as well as provide supportive care including oxygen supplementation if hypoxemia is present, as noted in 2. Chest tube placement is generally avoided unless there's an associated pneumothorax or hemothorax. The underlying cause of the extrapleural hematoma should be addressed to prevent recurrence, and these hematomas form between the parietal pleura and endothoracic fascia, making them distinct from pleural collections and requiring specific management approaches, as discussed in 3 and 4.