Treatment of emothorax from penetrating and contusive trauma. A single institute experience of 135 cases.

Introduction: To evaluate treatment modalities of penetrating and/or contusive hemothorax, we reviewed our experience with patientsadmitted for traumatic hemothorax to our Center for Thoracic Surgery. Material and Methods: From January 1998 to May 2009 we treated 135 consecutive patients (mean age, 47 + 22 SD years; M/F, 111/24) presenting traumatic hemothorax: 122 patients had contusive hemothorax (CONT) following car accident (28%), fall (27%), motorbike accident (25%), crushing trauma (7%), bike accident (3%); 13 patients had penetrating trauma (PEN) following stab wound (6.5%), gunshot (2%) and impalement (1.5%). We recorded demographic data, Injury Severity Score (ISS) at admission, endo- and extrathoracic injuries, method of treatment and outcome. Results: There were no statistically significative differences between CONT group and PEN group regarding mean age (47 vs 45 years), gender (M/F = 100/22 vs 11/2), mean ISS (30 vs 28) and ICU admission rate (51% vs 54%). The CONT group however presenteda higher rate of extrathoracic lesions (bone, visceral, CNS) than the PEN group (71.3% vs 31%: p < 0.005). In all patients a chest tube was immediately inserted, as the definitive treatment in 75% of CONT pts and in 46% of PEN pts (p < 0.05). Surgical treatment was mandatory respectively in 31/122 pts (25%) of CONT pts and in 7/13 pts (54%) of PEN pts. All 7 patients with PEN trauma received urgent thoracotomy on the same day of admission, whereas 16/122 (13%) of CONT pts had videothoracoscopic (VTS) treatment (5 + 4 days from trauma) and only 15/122 (12%) pts had open thoracotomy on the same day (p < 0.001 compared with PEN hemothorax). Perioperative mortality was higher in the PEN group, but not statistically different (8.1% CONT vs 15.3% PEN, p = 0.3) Conclusion: Compared to CONT patients, the PEN patients were at higher risk, requiring immediate thoracotomy for treatment in 54% of cases; in 13% of CONT patients, VTS treatment was necessary to remove clots and allow lung reexpansion and it was performed successfully in all such cases a few days after trauma. Disclosure: No significant relationships.