Predictors of initial management failure in traumatic hemothorax: A prospective multicenter cohort analysis.

BACKGROUND: Traumatic hemothorax is common, and management failure leads to worse outcomes. We sought to determine predictive factors and understand the role of trauma center performance in hemothorax management failure. METHODS: We prospectively examined initial hemothorax management (observation, pleural drainage, surgery) and failure requiring secondary intervention in 17 trauma centers. We defined hemothorax management failure requiring secondary intervention as thrombolytic administration, tube thoracostomy, image-guided drainage, or surgery after failure of the initial management strategy at the discretion of the treating trauma surgeon. Patient-level predictors of hemothorax management failure requiring secondary intervention were identified for 2 subgroups: initial observation and immediate pleural drainage. Trauma centers were divided into quartiles by hemothorax management failure requiring secondary intervention rate and hierarchical logistic regression quantified variation. RESULTS: Of 995 hemothoraces in 967 patients, 186 (19%) developed hemothorax management failure requiring secondary intervention. The frequency of hemothorax management failure requiring secondary intervention increased from observation to pleural drainage to surgical intervention (12%, 22%, and 35%, respectively). The number of ribs fractured (odds ratio 1.12 per fracture; 95% confidence interval 1.00-1.26) and pulmonary contusion (odds ratio 2.25, 95% confidence interval 1.03-4.91) predicted hemothorax management failure requiring secondary intervention in the observation subgroup, whereas chest injury severity (odds ratio 1.58; 95% confidence interval 1.17-2.12) and initial hemothorax volume evacuated (odds ratio 1.10 per 100 mL; 95% confidence interval 1.05-1.16) predicted hemothorax management failure requiring secondary intervention after pleural drainage. After adjusting for patient characteristics in the logistic regression model for hemothorax management failure requiring secondary intervention, patients treated at high hemothorax management failure requiring secondary intervention trauma centers were 6 times more likely to undergo an intervention after initial hemothorax management failure than patients treated in low hemothorax management failure requiring secondary intervention trauma centers (odds ratio 6.18, 95% confidence interval 3.41-11.21). CONCLUSION: Failure of initial management of traumatic hemothorax is common and highly variable across trauma centers. Assessing patient selection for a given management strategy and center-level practices represent opportunities to improve outcomes from traumatic hemothorax.

Hemotórax mortal secundario a lesiones de arterias intercostales posteriores: Reporte de caso / Fatal hemothorax secondary to posterior intercostal artery injuries: case report

Resumen La lesión de la arteria intercostal es un diagnóstico diferencial poco sospechado. Puede complicarse con una inestabilidad hemodinámica por un hemotórax o un hematoma intratorácico, lo que contribuye a su morbilidad y mortalidad. Se reporta el caso de un paciente de 61 años sin antecedentes patológicos conocidos que acudió al servicio de urgencias por dolor asociado a dificultad respiratoria posterior a un trauma torácico cerrado por caída de 8 días de evolución. Los estudios de imagen revelaron un hemotórax derecho, que ameritó la colocación de un tubo pleural. Se realizó una laparotomía exploratoria sin evidencia de hemorragias ni colecciones intrabdominales, y que posteriormente falleció. En el examen de necropsia se evidenciaron fracturas del noveno y décimo arco costal posterior derecho, asociado a un hematoma. El hemotórax secundario a la lesión de la arteria intercostal es poco frecuente, pero es una emergencia que requiere un diagnóstico asertivo y una intervención oportuna.

Abstract Intercostal artery injury is a poorly suspected differential diagnosis. It can be complicated by hemodynamic instability due to hemothorax or intrathoracic hematoma, which contributes to morbidity and mortality. We report the case of a 61-year-old patient with no pathological history known, who was presented to the emergency department for pain associated with respiratory distress following a blunt chest trauma due to a fall 8 days earlier. The Imaging studies revealed a right hemothorax, which required the placement of a pleural tube. An exploratory laparotomy was performed without evidence of bleeding or intra-abdominal collections, and he subsequently died. The necropsy examination revealed fractures of the ninth and tenth right posterior costal arch, associated with a posterior costal hematoma. The hemothorax that is secondary to an intercostal artery injury is rare, but it is an emergency that requires assertive diagnosis and timely intervention.

Hemothorax after oocyte retrieval in a patient with a history of COVID-19: a case report.

Spontaneous hemothorax is a rare disorder characterized by pleural fluid hematocrit greater than 50% of the peripheral blood hematocrit without natural or iatrogenic trauma to the lungs or pleural space. Since the first case of COVID-19, more than 85 million cases have been confirmed and most patients have sustained symptoms after more than six months of acute infection. This paper reports the case of a 38-year-old woman without signs of endometriosis and a history of COVID-19 infection who developed spontaneous hemothorax after oocyte retrieval. Three months before undergoing assisted reproductive technology (ART) treatment, the patient had a symptomatic COVID-19 infection with a negative PCR test and a positive IgG test four weeks after the onset of symptoms. Controlled ovarian stimulation and oocyte retrieval were conducted uneventfully. Two hours after oocyte retrieval, the patient developed nausea and mild hypogastric pain. Ten hours after the procedure, the patient went to the emergency department with abdominal pain. Chest computed tomography scans revealed moderate right pleural effusion and laminar left pleural effusion. Since the patient had respiratory symptoms, the choice was made to drain the pleural fluid. Fluid analysis confirmed the patient had right hemothorax (400 mL). After drainage, the patient's clinical and imaging signs improved gradually without complications. The patient was asymptomatic one week after the procedure.

Lesiones precordiales: reporte de dos casos / Precordial injuries: report of two cases

Las heridas precordiales son una entidad poco frecuente y desafiante en cirugía de trauma en los servicios de Emergencia. La incidencia elevada de taponamiento y trauma cardiaco, así como su alta mortalidad obliga a tomar decisiones diagnósticas y terapéuticas rápidas y precisas. Material y Métodos: se presentan los casos de dos pacientes masculinos que ingresaron al servicio de Emergencia del Hospital Roosevelt con lesiones precordiales penetrantes con trauma pericárdico y cardiaco, con diferentes manifestaciones clínicas a los que se les realizó ventana pericárdica subxifoidea diagnóstica y seguido una esternotomía media con exposición pericárdica y cardiaca como abordaje y tratamiento quirúrgico definitivo. Discusión: Es de suma importancia reconocer los amplios escenarios de presentaciones clínicas del paciente con heridas en la región precordial y mantener un alto índice de sospecha de trauma y taponamiento cardiacos en todas las lesiones precordiales penetrantes en pacientes estables e inestables para no retrasar el diagnóstico y tratamiento quirúrgico temprano y adecuado. Las lesiones asociadas y complicaciones trans y postoperatorias aumentan la mortalidad de estos pacientes (AU)

Precordial wounds are rare and challenging lesions in Trauma Services. The high incidence of cardiac trauma and the high mortality requires fast and precise diagnostic and therapeutic decisions. Case report: Two male patients who were admitted to the Roosevelt Hospital Emergency Service with penetrating precordial injuries with pericardial and cardiac trauma are presented, with different clinical manifestations, who underwent a diagnostic subxiphoid pericardial window and a median sternotomy with pericardial and cardiac exposure as a definitive surgical approach and treatment. Discussion: Is important to recognize the broad scenarios of patients with wounds in the precordial region and to maintain a high index of suspicion of cardiac trauma and tamponade in all penetrating precordial injuries inclusive in stable patients to not delay diagnosis and treatment and a proper surgical intervention. Associated injuries and perioperative complications increase the mortality of these patients

Fatal hemothorax caused by pleural mesothelioma in a lion / Hemotórax fatal causado por mesotelioma pleural em um leão

Mesothelioma is considered a malignant neoplasm caused by the proliferation of mesothelial cells mostly from the pleura, peritoneum and pericardium. Here we described a case of fatal hemothorax caused by pleural mesothelioma in a lion by means of necropsy, histopathology and immunohistochemistry. Gross inspection of the thoracic cavity showed hemothorax with about 4 liters of blood. Microscopically, numerous, randomly distributed, soft, red-pink, irregular masses with up to 1cm in diameter were observed in both visceral and parietal pleurae. Microscopically, a papillary structure pattern was observed in the thoracic masses, composed mainly by one layer of cubic mesothelial cells, which presented eosinophilic cytoplasm, central nucleus and evident nucleolus, supported by a low cellular fibrovascularstroma. Neoplastic cells were positive for both cytokeratin and vimentin by immunohistochemistry. This seems to be the first report of fatal hemothorax caused by pleural mesothelioma in a lion.(AU)

O mesotelioma é considerado um neoplasma maligna causada pela proliferação de células mesoteliais, principalmente da pleura, peritôneo e pericárdio. O presente caso descreve os achados macroscópicos, microscópicos e imuno-histoquímicos do hemotórax fatal causado por um mesotelioma pleural em um leão. Macroscopicamente, na cavidade torácica, foi observado cerca de 4 litros de sangue. Além disso, foram observadas numerosas massas macias, vermelho-rosa, irregulares, com até 1cm de diâmetro e distribuídas aleatoriamente pelas pleuras parietal e visceral. Microscopicamente, as massas torácicas apresentavam estruturas papilares, compostas por uma camada de células mesoteliais, que apresentavam citoplasma eosinofílico, núcleo central e nucléolo evidente, suportada por um estroma fibrovascular pouco celular. A imuno-histoquímica foi positiva para ambas citoqueratina e vimentina nas células neoplásicas. Este trabalho descreve o que parece ser o primeiro relato de um hemotórax fatal causado por um mesotelioma pleural em um leão.(AU)

Fatal hemothorax caused by pleural mesothelioma in a lion / Hemotórax fatal causado por mesotelioma pleural em um leão

Mesothelioma is considered a malignant neoplasm caused by the proliferation of mesothelial cells mostly from the pleura, peritoneum and pericardium. Here we described a case of fatal hemothorax caused by pleural mesothelioma in a lion by means of necropsy, histopathology and immunohistochemistry. Gross inspection of the thoracic cavity showed hemothorax with about 4 liters of blood. Microscopically, numerous, randomly distributed, soft, red-pink, irregular masses with up to 1cm in diameter were observed in both visceral and parietal pleurae. Microscopically, a papillary structure pattern was observed in the thoracic masses, composed mainly by one layer of cubic mesothelial cells, which presented eosinophilic cytoplasm, central nucleus and evident nucleolus, supported by a low cellular fibrovascularstroma. Neoplastic cells were positive for both cytokeratin and vimentin by immunohistochemistry. This seems to be the first report of fatal hemothorax caused by pleural mesothelioma in a lion.(AU)

O mesotelioma é considerado um neoplasma maligna causada pela proliferação de células mesoteliais, principalmente da pleura, peritôneo e pericárdio. O presente caso descreve os achados macroscópicos, microscópicos e imuno-histoquímicos do hemotórax fatal causado por um mesotelioma pleural em um leão. Macroscopicamente, na cavidade torácica, foi observado cerca de 4 litros de sangue. Além disso, foram observadas numerosas massas macias, vermelho-rosa, irregulares, com até 1cm de diâmetro e distribuídas aleatoriamente pelas pleuras parietal e visceral. Microscopicamente, as massas torácicas apresentavam estruturas papilares, compostas por uma camada de células mesoteliais, que apresentavam citoplasma eosinofílico, núcleo central e nucléolo evidente, suportada por um estroma fibrovascular pouco celular. A imuno-histoquímica foi positiva para ambas citoqueratina e vimentina nas células neoplásicas. Este trabalho descreve o que parece ser o primeiro relato de um hemotórax fatal causado por um mesotelioma pleural em um leão.(AU)

Aplication of videothoracoscopy in trauma--experience of a service.

OBJECTIVE: To evaluate patients with chest trauma submitted to videothoracoscopy during hospitalization. In 2007, the Trauma Surgery Group was created in the General Surgery Department of the Hospital Municipal Lourenço Jorge of Rio de Janeiro-RJ, and started following all trauma victims who were admitted to the Hospital. METHODS: We conducted a retrospective analysis of patients submitted to thoracoscopy from July 2007 to May 2015, based on a database started at the beginning of this period and on data collection from patients who underwent thoracoscopy. We evaluated the following parameters: procedure effectiveness, indication of the procedure, conversion rate, complications and mortality. We included patients who presented post-traumatic pleural collections, such as retained hemothorax and pleural empyema, and penetrating injury in the thoracoabdominal transition. All patients were hemodynamic stable and signed an informed consent. RESULTS: In the analyzed period 53 patients were submitted to videothoracoscopy; 24 had penetrating trauma (45.3%) and 29, blunt (54.7%), with a predominance of males (75.5%). The procedure was performed in 26 cases of retained hemothorax (49%), 14 cases of empyema (26.5%) and in 13 patients for evaluation of injury in the thoracoabdominal transition (24.5%). The thoracoscopy was effective in resolution of 36 cases (80%), without need for further procedure. There was a conversion rate of 15.5% and 3 procedure complications related (6.6%). Mortality was nil. CONCLUSION: In this series, videothoracoscopy proved that this diagnostic and therapeutic procedure is safe and effective, if performed by a surgeon with appropriate training, especially when it is indicated in cases of retained hemothorax and evaluation of penetrating thoracoabdominal trauma.

Aplication of videothoracoscopy in trauma - experience of a service / Aplicação da videotoracoscopia no trauma - experiência de um serviço

Objective: To evaluate patients with chest trauma submitted to videothoracoscopy during hospitalization. In 2007, the Trauma Surgery Group was created in the General Surgery Department of the Hospital Municipal Lourenço Jorge of Rio de Janeiro-RJ, and started following all trauma victims who were admitted to the Hospital. Methods : We conducted a retrospective analysis of patients submitted to thoracoscopy from July 2007 to May 2015, based on a database started at the beginning of this period and on data collection from patients who underwent thoracoscopy. We evaluated the following parameters: procedure effectiveness, indication of the procedure, conversion rate, complications and mortality. We included patients who presented post-traumatic pleural collections, such as retained hemothorax and pleural empyema, and penetrating injury in the thoracoabdominal transition. All patients were hemodynamic stable and signed an informed consent. Results: In the analyzed period 53 patients were submitted to videothoracoscopy; 24 had penetrating trauma (45.3%) and 29, blunt (54.7%), with a predominance of males (75.5%). The procedure was performed in 26 cases of retained hemothorax (49%), 14 cases of empyema (26.5%) and in 13 patients for evaluation of injury in the thoracoabdominal transition (24.5%). The thoracoscopy was effective in resolution of 36 cases (80%), without need for further procedure. There was a conversion rate of 15.5% and 3 procedure complications related (6.6%). Mortality was nil. Conclusion: In this series, videothoracoscopy proved that this diagnostic and therapeutic procedure is safe and effective, if performed by a surgeon with appropriate training, especially when it is indicated in cases of retained hemothorax and evaluation of penetrating thoracoabdominal trauma.

Objetivo: avaliar os resultados obtidos com o emprego da videotoracoscopia na avaliação dos traumas toracoabdominais e no tratamento das complicações do trauma torácico. Métodos: análise retrospectiva dos pacientes submetidos à videotoracoscopia no período de julho de 2007 a maio de 2015, com base em banco de dados criado no início deste período e na coleta dos dados dos pacientes submetidos à videotoracoscopia. Foram avaliados: a eficácia e as indicações do procedimento, a taxa de conversão, as complicações e mortalidade. Foram incluídos os pacientes que apresentavam coleções pleurais pós-traumáticas, como hemotórax retido e empiema pleural, e lesões penetrantes na transição toracoabdominal. Todos os pacientes submetidos apresentavam estabilidade hemodinâmica e consentimento informado do procedimento. Resultados: no período analisado, 53 pacientes foram submetidos à toracoscopia, dentre estes, 24 traumas penetrantes (45,3%) e 29 contusos (54,7%) com predominância do sexo masculino (75,5%). O procedimento foi realizado em 26 casos de hemotórax retido (49%), 14 empiemas (26,5%) e em 13 pacientes para avaliação de lesões da transição toracoabdominal (24,5%). A toracoscopia foi eficaz na resolução de 36 casos (80%) sem necessidade de novo procedimento. Houve uma a taxa de conversão de 15,5% e três complicações relacionadas ao procedimento (6,6%). A mortalidade foi nula. Conclusão: apesar da série ainda ser pequena, a videotoracoscopia é um procedimento factível, com várias indicações e aplicações em pacientes traumatizados e, na nossa série, a mortalidade foi nula e a incidência de complicações, pequena.

Hemorragias poco usuales en pacientes con hemofilia / Unusual bleeding in hemophilic patients

La hemofilia es una enfermedad hemorrágica grave con gran heterogeneidad fenotípica. Los sangramientos músculo-articulares constituyen la manifestación clínica más frecuente y significativa por las secuelas crónicas que originan. Sin embargo, existen otros sitios de sangramiento menos reiterados que pueden ser graves e invalidantes, y la posibilidad de reconocerlos tempranamente evita las consecuencias adversas. Se presentan dos pacientes de edad pediátrica que acudieron al servicio de urgencias por eventos hemorrágicos en sitios poco usuales: mediastinal, pulmonar y de rectos anteriores. A todos se les realizó un diagnóstico temprano del proceso patológico basado en un interrogatorio y examen físico detallados, apoyado con estudios imagenológicos (radiografía y ultrasonido) que permitieron manejar estas hemorragias de forma adecuada con terapia sustitutiva oportuna, sin complicaciones ulteriores. De esta forma se evidencia que el diagnóstico precoz es elemento fundamental en el seguimiento de los pacientes con hemofilia para evitar complicaciones de esta enfermedad(AU)

Hemophilia is a serious hemorrhagic disease with marked phenotypic heterogeneity. Muscle and joint bleedings are the most common clinical manifestation and they stand out by the resultant chronic sequelae. However, there are other less frequent types of bleeding disorders that can be severe and disabling and the possibility to recognize them early avoids adverse consequences. We present two pediatric patients who attended the emergency service with bleeding events in unusual places: mediastinal, pulmonary and rectus. These patients were early diagnosed based on a detailed interview and physical examination supported by imaging studies such as radiography and ultrasound which enabled the appropriate handling of these bleedings with opportune replacement therapy and without further complications. It is evident that early diagnosis is the key element in monitoring patients with hemophilia to prevent complications of the disease(AU)

Pseudo-hemothorax at computed tomography due to residual contrast media.

Pleural effusion is a clinical problem that has many causes, with hemothorax being one of them. Computed tomography readily characterizes pleural fluid with determination of the attenuation value, helping to distinguish hemothorax from other types of effusion. Herein, we report the case of a 67-year-old man with end-stage renal disease in which a high-density pleural effusion due to residual contrast media was misinterpreted as hemothorax. Radiologists should consider the possibility of contrast media retention when interpreting a high-density pleural effusion in patients with end-stage renal disease. Recognition of this entity is crucial to avoid misdiagnosis, which might lead to unnecessary testing or procedures.

Extralobar pulmonary sequestration with hemothorax secondary to pulmonary infarction.

Pulmonary sequestration is an uncommon condition that accounts for 0.5-6% of all pulmonary malformations and is typically diagnosed in childhood. Of the two forms of pulmonary sequestration, intralobar and extralobar, the latter is less frequently encountered. The current report describes the case of a 32-year-old female patient with chest and abdominal pain. Imaging (chest X-rays and CT scans of the chest) revealed consolidation and pleural effusion. The initial thoracocentesis revealed hemothorax. Subsequent diagnostic video-assisted thoracoscopy revealed extralobar pulmonary sequestration. Consequently, the therapeutic decision was to make the conversion to thoracotomy in order to resect the lesion and safely ligate the intercostal vascular pedicle.

Sequestro extralobar com hemotórax secundário a infarto pulmonar / Extralobar pulmonary sequestration with hemothorax secondary to pulmonary infarction

O sequestro pulmonar é uma malformação incomum, representando 0,5-6 por cento de todas as malformações pulmonares, sendo geralmente diagnosticado na infância. Dos dois tipos de sequestro pulmonar, intralobar e extralobar, este último é o menos freqüente. O presente relato descreve o caso de um paciente do sexo feminino, de 32 anos, com quadro de dor toracoabdominal e achados de radiografia e TC de tórax revelando consolidação e derrame pleural. A conduta inicial com toracocentese evidenciou hemotórax. A seqüência diagnóstica através da videotoracoscopia permitiu o diagnóstico de sequestro extralobar e a consequente conduta de conversão para toracotomia para ressecção da lesão com ligadura segura do pedículo vascular intercostal.

Pulmonary sequestration is an uncommon condition that accounts for 0.5-6 percent of all pulmonary malformations and is typically diagnosed in childhood. Of the two forms of pulmonary sequestration, intralobar and extralobar, the latter is less frequently encountered. The current report describes the case of a 32-year-old female patient with chest and abdominal pain. Imaging (chest X-rays and CT scans of the chest) revealed consolidation and pleural effusion. The initial thoracocentesis revealed hemothorax. Subsequent diagnostic video-assisted thoracoscopy revealed extralobar pulmonary sequestration. Consequently, the therapeutic decision was to make the conversion to thoracotomy in order to resect the lesion and safely ligate the intercostal vascular pedicle.

Hemorragia alveolar associada a nefrite lúpica / Alveolar hemorrhage associated with lupus nephritis

Hemorragia alveolar, como causa de insuficiência respiratória, é pouco freqüente, com diversas etiologias possíveis. Entre elas, o lúpus eritematoso sistêmico, que se apresenta geralmente como síndrome pulmão-rim, possui alta morbimortalidade. Acredita-se que a patogênese da microangiopatia, tanto renal como pulmonar, esteja associada ao depósito de imunocomplexos, que ativariam as vias de apoptose celular. Relatam-se dois casos de pacientes com nefrite lúpica que evoluíram com hemorragia alveolar associada à insuficiência respiratória necessitando de ventilação mecânica com evoluções totalmente distintas frente às terapias farmacológicas. O achado de anticorpos antimembrana basal em um dos casos evidencia a multiplicidade de mecanismos fisiopatológicos possivelmente envolvidos, que poderiam justificar as respostas heterogêneas frente aos tratamentos disponíveis.

Hemotórax por fístula arteriovenosa pulmonar durante el embarazo: reporte de un caso / Hemothorax due to lung arteriovenous fistula in pregnancy: case report

Una embarazada de 42 años de edad y 29 semanas de gestación, arribó al Servicio de Emergencias del Hospital Central Universitario "Antonio María Pineda" (HCUAMP), con disnea y signos de hipovolemia, diagnósticandose hemotórax derecho no traumático. Ameritó toracotomia cerrada y drenaje inicialmente, y luego se le realizó cesárea y neumonectomía parcial derecha debido a la presencia de una fístula arteriovenosa pulmonar. Estas son malformaciones vasculares pulmonares infrecuentes y existe una fuerte asociación entre estas y la enfermedad de Rendu-Osler-Weber. El Embarazo ha sido implicado en el deterioro súbito de estos pacientes, mas aún el mecanismo parece incierto. Discutimos el diagnostico y tratamiento de esta enfermedad

Estenosis bronquial secundaria a contusión torácica grave: comentario sobre dos casos / Bronchial stenosis secondary to acute thoracic contusion: comentary on two cases

Se presentan dos casos con estenosis total del bronquio principal consecutiva a contusión torácica grave. Un paciente tenía hemoneumotórax izquierdo y el otro hemotórax bilateral. Ambos se trataron inicialmente con drenaje a través de sondas para eliminar la colección hemática con resultados parciales. Posteriormente los dos pacientes presentaron atelectasia total del pulmón correspondiente, en uno se practicó decorticación pulmonar. En cada caso la fibrobroncoscopía demostró oclusión completa del bronquio principal. Se practicó broncoplastía con resección en manguito de la porción estenosada y anastomosis términoterminal con puntos separados de Vicryl 0000 para dejar libre la luz bronquial. Cada paciente se encuentra sin patología broncopulmonar, a cuatro años de la broncoplastía. Se enfatiza que debe considerarse la posibilidad de ruptura bronquial cuando ocurre contusión torácica grave, en cuyo caso la fibrobroncosccopía y el tratamiento quirúrgico inmediatos están indicados.

Hemotorax traumático: nuestra experiencia / Traumatic hemothorax: our experience

Antecedentes: el avenamiento pleural constituye una práctica del cirujano general. Objetivo: presentar los resultados iniciales de un estudio prospectivo de pacientes a los cuales se les realizó avenamiento pleural describiendo la tecnica empleada y los resultados. Lugar de aplicación: servicios de emergencias y de cirugia general del Hospital Interzonal General de Agudos "General San Martín", La Plata. Diseño: estudio observacional prospectivo. Población: muestra consecutiva de 36 avenamientos pleurales realizados en el período comprendido entre diciembre de 1997 y noviembre de 1998 inclusive. Método: se utilizó un protocolo que incluía datos personales, diagnóstico, etiopatogenia, gravedad, via de abordaje, material utilizado y seguimiento clínico-radiológico. Resultados: de un total de 36 avenamientos pleurales, 28 fueron hemoneumotorax (77,7 por ciento) y 8 hemotorax (22,2 por ciento). Conclusiones: conocer la fisiopatología del espacio pleural, tratamiento quirúrgico del hemotorax y su seguimiento. (AU)