From the Guidelines
Chest hematoma management should prioritize securing and maintaining an adequate airway and optimal oxygenation, particularly in cases of significant or massive hemoptysis, which may involve endotracheal intubation and selective mainstem intubation to protect the nonbleeding lung 1. When managing a chest hematoma, it is crucial to consider the underlying cause, which could be related to lung cancer, as hemoptysis is a presenting symptom in 7% to 10% of patients with lung cancer 1. The mechanisms responsible for hemoptysis include growth of new blood vessels, exfoliation of surface tumor, tumor necrosis, trauma from cough, and iatrogenic procedures 1.
Key Considerations
- Minor episodes of hemoptysis may not require bronchoscopic therapy, but significant hemoptysis may call for interventional procedures, including therapeutic bronchoscopy, bronchial or pulmonary angiography followed by therapeutic embolization, or surgery 1.
- Massive hemoptysis, defined as the expectoration of at least 200 mL of blood in 24 h, has a poorer prognosis and may require immediate intervention, including securing the airway and optimal oxygenation 1.
- Bronchoscopy is used for both diagnostic and therapeutic purposes in patients with massive hemoptysis, providing information on the anatomic site and side of bleeding, nature of the bleeding source, severity of bleeding, and therapeutic feasibility 1.
Treatment Approaches
- Treatment of significant or massive hemoptysis requires securing and maintaining an adequate airway and optimal oxygenation, usually necessitating endotracheal intubation 1.
- Selective right or left mainstem intubation can be performed to protect the nonbleeding lung, and a single-lumen cuffed endotracheal tube is generally more beneficial than a double-lumen endotracheal tube 1.
- Bronchoscopic visualization and management, including tamponade of the segment, instillation of iced saline solution, and use of vasoactive agents or bronchial blockade balloons, may be necessary to control bleeding 1.
- If these measures are unsuccessful, consideration should be given to bronchial artery embolization to temporize the bleeding 1.
From the Research
Definition and Causes of Chest Hematoma
- A chest hematoma, also known as a hemothorax, is a collection of blood in the space between the chest wall and the lung 2.
- Most cases of hemothorax are related to blunt or penetrating chest trauma 2.
- Spontaneous hemothorax is much less common and results from a variety of pathologic processes 2.
Diagnosis and Management of Chest Hematoma
- The diagnosis and management of traumatic and spontaneous hemothorax are critical, and the best approach remains controversial 2.
- Initial management and resuscitation of severe chest trauma are crucial, and more than 80% of patients will be managed with interventions that can be performed in the emergency department 3.
- The management of blunt chest injuries, including hemothorax, requires a structured approach to guide resuscitation decisions 4.
Treatment and Complications of Chest Hematoma
- The treatment of hemothorax may involve surgical intervention, and the criteria for surgical intervention are well defined 2.
- Chest trauma is commonly encountered, and anesthesiologists have the potential to significantly improve morbidity and mortality in this group of patients 5.
- Complications of chest hematoma, such as acute respiratory distress syndrome (ARDS), can be life-threatening and require evidence-based management approaches 6.