Hemopneumothorax

Classification according to ICD-10
J94.2	Hemopneumothorax
S27.2	Haematopneumothorax, traumatic
ICD-10 online (WHO version 2019)

CT thorax of a patient after chest trauma with pneumothorax , hemothorax , pneumomediastinum and pneumopericardium .

A hemopneumothorax occurs with chest trauma or iatrogenic lung injury. This results in a combination of a hemothorax and a pneumothorax.

causes

A hemopneumothorax occurs as a result of a chest trauma or iatrogenically, e.g. B. after punctures or postoperatively. The cause is an injury to the lungs, the airways or, more rarely, the esophagus and blood vessels, so that air and blood enter the pleural space and the affected lungs collapse. In addition, the bleeding into the thorax leads to mechanical compression of the affected side of the lung. In the case of tension hemopneumothorax, the development of a valve mechanism leads to a progressive increase in intrathoracic pressure on the affected side, with the resulting compression and displacement of the mediastinum . In the case of bilateral tension hemopneumothorax, there is no displacement of the mediastinum, the shock symptoms are caused by the compression of the mediastinum and the impaired breathing mechanics.

Symptoms

Small haematopneumothoraces, e.g. B. after punctures, can remain symptom-free. It can for injuries that lead to a collapse of the affected lung to shortness of breath , increased respiratory rate , slower breathing sound and pain come. Depending on the extent of the pneumothorax and hemothorax, hypersonic or attenuated knocking sounds occur . If a valve mechanism causes the pneumothorax to progress, a hemato tension pneumothorax can develop, which is acutely life-threatening. This leads to acute shortness of breath and cyanosis . The displacement of the mediastinum leads to venous congestion, which is noticeable through congested neck veins. As the compression progresses, hypotension, tachycardia and shock symptoms up to cardiovascular arrest occur . Depending on the origin of the bleeding, hemodynamically effective blood loss can also occur, which is also noticeable with symptoms of shock.

Diagnosis

After inspecting the chest for external signs of injury, auscultation is the first diagnostic tool. A chest x-ray may show a collapsed lungs or a build-up of fluid in the chest. While fluids in the chest x-ray can be seen from 200 ml, an ultrasound examination shows intrathoracic fluid volumes from 50 ml. A chest CT shows intrathoracic injuries and fluid or air accumulations with accuracy. Digital subtraction angiography is suitable as a diagnostic tool for detecting vascular injuries .

therapy

Small hemopneumothoraces often do not require any special therapy. Observation and follow-up is sufficient here. If the lungs collapse, relief with a chest drain is necessary. A tension hemopneumothorax must be relieved immediately, if necessary by means of a puncture. If there is an initial loss of blood from the drain between 1000 and 2000 ml or a continued blood loss of more than 150-300 ml per hour, thoracotomy and operative hemostasis are indicated.

Literature and Sources

• Ralf H. Gahr (Ed.): Handbook of Thorax Traumatology. Volume 1-2. Einhorn-Presse, Hamburg 2007, ISBN 978-3-88756-812-2 .

Individual evidence

1. ↑ ^{a b} Ralf H. Gahr (Ed.): Handbook of Thorax Traumatology. Volume 1-2. Einhorn-Presse, Hamburg 2007, ISBN 978-3-88756-812-2 .

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