What is the role of CT scanning in the workup of hemothorax?

Updated: Jul 13, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Jeffrey C Milliken, MD  more...
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Answer

Thoracic CT (see the image below) has a definite role to play in evaluation of hemothorax, particularly if plain radiography results are ambiguous or initial therapy is inadequate. [34, 35] CT is a highly accurate diagnostic study for pleural fluid or blood and is particularly helpful in localizing loculated collections of blood.

Contrast-enhanced CT scan of patient with right he Contrast-enhanced CT scan of patient with right hemothorax.

In the trauma setting, CT does not play a primary role in the diagnosis of hemothorax but is complementary to chest radiography. Because many victims of blunt trauma do undergo evaluation with chest CT, abdominal CT, or both, hemothorax not evident on initial chest radiographs might be identified and treated.

Currently, CT is of greatest value later in the course of management of the chest trauma patient, in particular for localization and quantification of any retained collections of clot within the pleural space.

Although multidetector CT allows for the accurate diagnosis of most traumatic injuries, in pediatric patients it should be used in selected cases only. Routine use would result in an unacceptably high radiation exposure to a large number of patients without proven clinical benefit. [36]


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