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Approximately 5% of patients with traumatic hemothorax treated with tube thoracostomy have residual effusions, usually from tube malposition, migration, or obstruction. Because empyema or fibrous hemothorax can develop from undrained hemothoraces, invasive procedures, such as open thoracotomy and video-assisted thoracoscopic surgery, are performed to evacuate the residual blood. Investigators evaluated the efficacy and safety of intrapleural thrombolysis administered by chest tube or pigtail catheter.
During a 16-month period at a single trauma center, 203 patients (mean age, 32), most (74%) with penetrating injury, had traumatic hemothoraces that were treated by tube thoracostomy. Of these patients, 25 had undrained hemothoraces, defined as…