Nomenclature, Classification, and Significance of Traumatic Extrapleural Hematoma

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BackgroundExtrapleural hematoma has been found mostly in single case reports as diagnoses with different names. Although huge extrapleural hematoma can cause ventilatory and circulatory disturbances and even death, it has received almost no attention in the literature. Certain basic and modern facts need to be clarified regarding the definition, classification, and significance of extrapleural hematoma in the practice of chest trauma.MethodsA 10-year retrospective study was undertaken to analyze the incidence, diagnosis, management, morbidity, and mortality of patients with chest trauma and a documented extrapleural hematoma.ResultsThe incidence of traumatic extrapleural hematoma was 34 of 477, 7.1%. The incidence of thoracic lesions was 86 of 34 = 2.5 lesions per patient, whereas the incidence of extrathoracic lesions was 30 of 34 = 0.9 lesions per patient. Associated rib fractures were found in 30 of 34, 88.2%. More than half of the patients had an associated hemothorax. A thoracotomy was used successfully to remove a huge hematoma in one patient.ConclusionExtrapleural hematoma has been found to be more common than previously reported. Nomenclature and classification are suggested. One of the common injuries to the chest, particularly rib fracture, hemothorax, lung contusion, or pneumothorax might provide the surgeon with a reliable clinical clue that the patient is at inordinate risk to have associated extrapleural hematoma. A formal or mini-thoracotomy is the recommended procedure in cases of huge hematomas.

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