PNEUMOHEMOTHORAX
A moderate left-side pneumohemothorax and right apical pneumothorax was identified. The left-side pneumohemothorax was treated with chest tube thoracotomy in the trauma bay. A pneumothorax is the presence of air in the pleural space. Advanced Trauma Life Support recommends tube thoracostomy for all traumatic pneumothoraces to avoid advancement into a life-threatening tension pneumothorax.5 Pneumohemothoraces are diagnosed by chest radiograph, but diagnosis is limited if it is less than 400 to 500 mL. CT scanning of the chest is the gold standard for diagnosis. Hemothoraces should be drained with a chest tube regardless of the size to avoid complications such as retained hemothorax, fibrothorax, and empyema. Indications for open thoracotomy in the operating room include initial output of hemothorax drainage greater than 1500 mL, ongoing drainage greater than 200 mL/hr, or ongoing blood transfusions necessary to maintain hemodynamic stability. Retained hemothoraces are treated with video-assisted thoracotomy, ideally in the first 3 to 7 days to reduce the risk of infection.6