About hemothorax -a) Seen in choriocarcinomab) Supine posture is better than erect posturec) Needle aspiration may be needed for diagnosisd) Thoracotomy is always done
Hemothorax: Causes

trauma (most common)
tumor
tuberculosis
Diagnosis is made by needle aspiration of pleural fluid.
Harrison writes that for making a diagnosis of hemothorax, the pleural fluid hematocrit should be > 50% of the peripheral blood.
Chest X rays are taken to assess the presence and extent of pleural cavity collection (blood or simple plural fluid)
a supine position with horizontal x-ray beam (k/a decubitus position) is better than an erect film, as about 400-500 ml of blood may be hidden by diaphragm on upright chest x-ray.

Management of hemothorax

Most of the hemothorax can be t/t effectively with a large bore chest tube drainage and in most of the cases the bleeding stops as the lungs re-expands.
A small number of cases will require thoracotomy
continued bleeding
a significant blood clot has formed.
Currently, most hemothoraces requiring more than simple tube drainage can be managed with Videothoracoscopy. Thoracotomy may be needed only if more extensive exposure is needed to manage an active source of bleeding or if extensive decortication of the lung is necessary.
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