Early and Persistent Hemothorax and Pneumothorax

The incidence of traumatic injury to the thorax is estimated at up to 40 % of patients that require hospitalization. The vast majority of these injuries can be managed with observation. However, the presence of pneumothorax or hemothorax has traditionally mandated tube thoracostomy placement and the inherent morbidities that may arise. Persistent pneumothorax is typically defined as the presence of pneumothorax and/or air leak for 5–7 days after tube placement. This morbidity may be managed expectantly or with video-assisted thoracoscopic surgery (VATS). The most feared complication after hemothorax is the presence of retained blood and the risk of infection that follows. Most authorities support the early use of VATS to resolve retained hemothoraces with the hopes of avoiding more invasive procedures aimed at the treatment of fibrothorax and empyema.