From the Guidelines
Chest wall hematoma management should prioritize a multidisciplinary approach, focusing on pain control, pulmonary hygiene, and close monitoring for complications, with surgical intervention considered for cases with significant respiratory compromise or instability, as evidenced by recent studies on surgical stabilization of rib fractures 1.
The management of chest wall hematoma is crucial to prevent further complications such as respiratory failure, infection, or abscess formation. Given the potential for significant morbidity and mortality associated with thoracic trauma 1, it is essential to adopt a proactive approach. This includes multimodal analgesia to manage pain effectively, pulmonary hygiene measures like chest physiotherapy, and pleural drainage as needed 1.
For patients with small, stable hematomas and minimal symptoms, conservative management can be sufficient, including rest, ice application, and over-the-counter pain medications like acetaminophen or ibuprofen if not contraindicated. However, larger hematomas or those causing significant symptoms may require more aggressive medical intervention, including drainage or surgical stabilization, especially if there are signs of infection, respiratory compromise, or instability 1.
It is critical for patients to seek immediate medical attention if they experience increasing pain, shortness of breath, fever, or expanding swelling, as these could be indicative of complications requiring prompt intervention. The resolution of chest wall hematomas typically occurs within 1-3 weeks with proper management, but this can vary based on the size of the hematoma and the patient's overall health, with those having bleeding disorders or taking anticoagulants potentially experiencing slower resolution 1.
Key considerations in the management of chest wall hematoma include:
- Multidisciplinary care approach
- Effective pain management
- Close monitoring for complications
- Consideration of surgical intervention for significant cases
- Patient education on signs of complications requiring immediate medical attention.
From the Research
Causes of Chest Wall Hematoma
- Spontaneous chest wall hematoma is rare and has been associated with neoplasms and arteriovenous malformations 2
- The increasing use of anticoagulant and antiplatelet agents has increased the clinical presentation of spontaneous hematomas 2
- Dual antiplatelet therapy with clopidogrel and aspirin can increase the risk of spontaneous chest wall hematoma 2
Diagnosis and Management
- Hemothorax, which can be related to chest wall hematoma, can be caused by blunt or penetrating chest trauma, and spontaneous hemothorax can result from various pathologic processes 3
- Thoracentesis, a procedure that can be used to diagnose and manage hemothorax, carries risks of complications such as pneumothorax, bleeding (including chest wall hematoma and hemothorax), and re-expansion pulmonary edema 4
- The use of anticoagulant or antiplatelet medications, such as those that can cause spontaneous chest wall hematoma, has traditionally been viewed as a contraindication to thoracentesis, but new evidence suggests that patients may be able to safely undergo thoracentesis without treating their bleeding risk 4
Treatment Options
- Tranexamic acid, an antifibrinolytic agent, is commonly used for the treatment or prevention of bleeding, and has been used in various clinical settings, including trauma, postpartum hemorrhage, and surgical site bleeding 5
- Tranexamic acid has also been used as a nonsurgical option for the treatment of recurrent subdural hematomas following surgery, and may be considered for the treatment of recurrent hematomas in patients for whom additional surgery would add significant morbidity 6