How are the sequelae of hemothorax treated?
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The late sequelae of hemothorax, including residual clot, infected collections, and trapped lung, require additional treatment and, most often, surgical intervention.
Retained clot (defined as an undrained collection of 500 mL or more as estimated by computed tomography [CT] or opacification of one third or more of the chest on chest radiography) is a well-known sequela after initial tube thoracostomy for hemothorax and should be evacuated early in the patient's hospital course, if the clinical condition permits. Early intervention in the case of a retained clot can be performed with thoracoscopy, provided that the operation is planned within 1 week of the bleeding episode.
Empyema usually develops from superimposed infection in a retained collection of blood. It requires surgical drainage and, possibly, decortication.
Fibrothorax is a late uncommon complication that can result from retained hemothorax. Thoracotomy and decortication are required for treatment.