Hemopneumothorax

A Hämatopneumothorax occurs in thoracic trauma or iatrogenic lung injury. Here, there is a combination of a pneumothorax and hemothorax.

Causes

A Hämatopneumothorax occurs as a result of thoracic trauma or iatrogenic, for example, by punctures or postoperatively on. Cause is a violation of the lungs, respiratory tract or, less frequently of the esophagus and blood vessels, so that air and blood pass into the pleural cavity and collapsing the affected lung. In addition, it comes by bleeding into the thorax to a mechanical compression of the affected lung side. When it comes Spannungshämatopneumothorax by forming a valve mechanism to a progressive increase in intrathoracic pressure on the affected side, with consequent compression and displacement of the mediastinum. With a two-sided Spannungshämatopneumothorax a shift of the mediastinum remains off the symptoms of shock comes through the compression of the mediastinum, and by handicapped respiratory mechanics about.

Symptoms

Small Hämatopneumothoraces, for example, by punctures, can remain asymptomatic. For injuries that lead to a collapse of the affected lung may lead to shortness of breath, increased respiratory rate, slower breathing noise and pain. Depending on the extent of pneumothorax and hemothorax occurs hypersonorem or attenuated percussion. If, by a valve mechanism to a progression of the pneumothorax can develop a Hämatospannungspneumothorax who is acutely life- threatening. This leads to acute Luftnotund and cyanosis. Due to the displacement of the mediastinum leads to venous congestion, which is manifested by jammed neck veins. In advanced compression results in hypotension, tachycardia, and symptoms of shock or even heart and circulatory standstill. Depending on the origin of the bleeding can also occur to a hemodynamically significant blood loss, which also makes itself felt with shock symptoms.

Diagnostics

After inspection of the thorax on external signs of injury auscultation is initially the first diagnostic means. A chest X-ray absorption, a collapsed lung or fluid accumulation point of the chest. While liquids in the chest X-ray can be seen from 200 ml, shows an ultrasound already intrathoracic fluid volumes from 50 ml A chest CT shows an accuracy intrathoracic injuries and fluid or air collections. As a diagnostic agent for the detection of vascular injuries is suitable digital subtraction.

Therapy

Small Hämathopneumothoraces often require no specific therapy. An observation and follow-up is sufficient. If there is a collapse of the lung, a relief by thoracic drainage is necessary. A Spannungshämatopneumothorax must immediately be relieved, if necessary by means of a puncture. In an initial blood loss from the drainage between 1000 and 2000 ml or from continuous blood loss of more than 150-300 ml per hour, a thoracotomy and surgical hemostasis is displayed.

Literature and sources

• Ralf Gahr (ed.), "Handbook of Thoracic Trauma, Volume I and II " Unicorn Press Publisher ISBN 978-3-88756-812-2