Imaging

Hemothorax

Preliminary Diagnosis: Hemothorax

I. What imaging technique is first-line for this diagnosis

  • Chest x-ray, PA and lateral view

II. Describe the advantages and disadvantages of this technique for diagnosis of hemothorax.

Advantages

  • Relatively inexpensive, fast imaging modality

  • Highly portable imaging modality

  • Exposes patients to negligible ionizing radiation

Disadvantages

  • Less sensitive in characterizing the type and content of pleural fluid

  • Less sensitive and specific in detailing any underlying pleural or parenchymal abnormality or secondary complication compared to CT imaging

III. What are the contraindications for the first-line imaging technique?

  • No specific contraindications to plain radiography exist. Some institutions may require consent for pregnant patients.

IV. What alternative imaging techniques are available?

  • CT of the chest with intravenous contrast

  • Ultrasound Imaging of the pleural process

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of hemothorax.

CT of the chest with intravenous contrast

Advantages

  • Gold standard for evaluating and characterizing any pleural process

  • Can exquisitely detail any underlying pulmonary or parenchymal process or detail any secondary complication

  • Can better detail and define the primary source of hemothorax

  • May potentially guide treatment

Disadvantages

  • Exposes patients to ionizing radiation

Ultrasound

Advantages

  • Highly portable

  • Less expensive imaging modality than CT imaging

  • Does not expose patients to ionizing radiation

  • May guide treatment of the hemothorax

Disadvantages

  • Highly operator dependent and does not penetrate through bone or air

  • Less adept in detailing any particular underlying pleural or parenchymal process or any secondary complication compared to CT

VI. What are the contraindications for the alternative imaging techniques?

CT of the chest with intravenous contrast

  • May be contraindicated in pregnant patients

Ultrasound

  • No specific contraindications to ultrasound imaging exist

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