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PubMed1976

[Hemothorax--a life-threatening complications of spontaneous pneumothorax (author's transl)].

A 23-year old male with an spontaneous hemopneumothorax and in the state of severe shock was admitted to our hospital. The etiology, incidence and therapeutic measures are discussed. It is recommended that patients with spontaneous hemopneumothorax after securing the diagnosis by radiography and puncture biopsy have to be admitted immediately in a thoracic surgery clinic. An early thoracotomy is favourable.

Adult↗
PubMed1998

[Successful treatment of hemothorax with recombinant factor VIIa in a hemophilic child with inhibitor].

rFVIIa is at present the most progressive treatment in different haemorrhages and operations in patients with haemophilia A and a high titre of inhibitor. As apparent from the presented case of a 4-year-old boy with haemorrhage into the pleural cavity, rFVIIa is sufficiently effective to induce haemostasis, while it is safe and has no side-effects. It does not induce systemic activation of haemostasis. Its application requires, due to the high price, that all criteria should be met which were elaborated for the Slovak Republic in the National centre of haemostasis and thrombosis.

Child, Preschool↗
PubMed1999

[Current value of intrapleural fibrinolysis in the treatment of exudative fibrinous pleural effusions in pleural empyema and hemothorax].

Intrapleural administration of fibrinolytic agents has been in use for fifty years; it has, however, been of clinical importance only for the last twenty years. Parallel to clinical reports procoagulant and fibrinolytic activities in pleural effusions are studied. Most types of pleural injury are characterised by fibrin deposition in the pleural space promoted by concurrent local abnormalities of pathways of fibrin formation and its clearance. Many of the studies of intrapleural fibrinolytics are uncontrolled and retrospective or small and are therefore of limited statistical value. Only five of the studies which are presented in the table are controlled and comparative studies. Intrapleural fibrinolytic therapy was used in exudative fibrinous multi-loculated pleural effusions, pleural empyemas and haemothorax. The global success rate of the studies cited were between 44% and 100%, in most cases more than 80%. The great differences in success rates are due to variations in the pleural diseases and stages of the clinical course, different success criteria, different dosages of fibrinolytic agents, different durations of clamped chest tube drainage and different starting points of therapy during the hospital course. The number of patients enrolled in each study ranged from 8 to 98, the number of children ranged from 2 to 9. Intrapleural fibrinolytic treatment is associated with rare adverse effects. There is no significant systemic fibrinolytic activity of intrapleural fibrinolysis. Intrapleural administration of streptokinase has been reported to lead to antibody formation. Hence, intrapleural fibrinolytic therapy is a useful adjunct in the management of exudative fibrinous multi-loculated pleural effusions, pleural empyemas and haemothorax. There is an increased volume of pleural fluid drainage during the treatment phase, and intrapleural fibrinolysis may reduce the need for more invasive surgical procedures. On the basis of the data of literature we recommend to use a single daily dose of 250,000 U streptokinase or 100,000 U urokinase in 50-100 ml normal saline instilled into a chest tube and to maintain dwell times of 2 to 4 hours. Therapy can be continued up to 2 weeks. The pleural space can be drained by large bore chest tubes or small drainage catheters, both radiologically guided, without preference for one method.

Empyema, Pleural↗