Case 6: Chest x-ray in trauma
Monday, January 31st, 2011This is the chest x-ray of a 76 your old man who has been brought into the emergency department after falling from a ladder. He is complaining of right sided chest pain.
You can just make out undisplaced fractures of several right-sided ribs.
1. Are there any other significant features apparent on this chest x-ray?
Click to see the answerThere is a general haziness of the right lung field. This is suggestive of a haemothorax which, in the supine patient, has spread along the back of the chest cavity. The extent of the haemothorax is apparent in the CT scan taken shortly afterwards.
2. What is the management of this problem, both in ED and subsequently?
Click to see the answerInitial management is by chest drain. This should be of sufficient calibre to allow blood to drain freely (32 to 36 gauge recommended). Only very small haemothoraces should remain undrained, as the residual blood may become infected, or produce long-term scarring.
The vast majority of bleeding due to blunt trauma will stop spontaneously and no further intervention than chest drainage is required.
In penetrating trauma there is a high risk of arterial bleeding. If bleeding continues over several hours, at more than 200-250mls per hour surgery is likely to be needed. Darker venous bleeding is more likely to stop spontaneously than brighter arterial bleeding.