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Journal of Radiological Review 2020 July-August;7(4):300-6

DOI: 10.23736/S2723-9284.20.00050-X


language: English, Italian

Traumatic and spontaneous hemothorax due to intercostal arteries hemorrhage: what the interventional radiologist needs to know

Milena COPPOLA , Francesco PANE, Antonio BORZELLI, Fabio CORVINO, Francesco GIURAZZA, Mattia SILVESTRE, Raffaella NIOLA

Unit of Vascular and Interventional Radiology, AORN A. Cardarelli, Naples, Italy


Hemothorax is caused by collection of blood within the pleural cavity; most cases result from direct thoracic trauma or iatrogenic causes (thoracentesis, catheter positioning etc.) but a subcategory exists called spontaneous hemothorax not consequent to trauma. Multiple clinical conditions are related to this form of hemothorax but the most frequent are pneumothorax or coagulopathy. Chest radiography allows an initial evaluation but CT-angiography plays a crucial role both in the diagnostic path, aimed to identifying the causes of the hemothorax, and in the subsequent therapeutic planning: an arterial blush identified on CT indicates ongoing bleeding and it is an indication for urgent intervention. Management depends on patient stability and type of injuries leading on hemothorax: in stable patients thoracoscopic draining can be performed while in hemodynamically unstable patients exploratory thoracotomy represents the therapeutic gold standard, but the latter typically results in significant morbidity and low yield of finding the bleeding source. Nowadays transcatheter arterial embolization (TAE) is considered an effective and valid option in cases of hemothorax due to intercostal arteries (ICAs) laceration, especially in patients with severe associated injuries, serious medical comorbidities and in those who are poor surgical candidates. Different embolics can be adopted; the goal is to achieve prompt stop-flow in the injured vessel. It is crucial to consider the anatomical features of the ICAs and the possible collateral pathways to avoid both rebleeding from collateral vessels and complications connected to embolization itself, mainly non target embolization in the medullary network.

KEY WORDS: Hemothorax; Bronchial arteries; Therapeutic embolization

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