Diagnosis and treatment of coagulated hemothorax after a gunshot injury to the chest at the stage of specialized care

Levchuk A.L., Ablicov A.Yu., Orlov S.S.

Relevance: Coagulated hemothorax is the most common complication of penetrating gunshot wounds to the chest, requiring surgical treatment in most patients.

Materials and methods: From 2023 to 2024, videothoracoscopy was performed on 43 victims with complications of penetrating gunshot wounds to the chest. Coagulated hemothorax was detected in 39 patients (90.7%).

Results: Spiral computed tomography with Hounsfield lesion density testing has the highest diagnostic capabilities for this pathology (specificity – 93% and sensitivity – 100%). It was established that the main cause of this complication was incorrect installation and inadequate function of pleural drainage. Coagulated hemothorax developed after pleural drainage and primary surgical treatment in 33 victims (76.7%), after atypical thoracotomy – in 4 wounded (10.3%) and in 2 patients (5.1%) after typical thoracotomy. The average interval between surgeries was 7.4±6 days.

Conclusion. The best results of treating clotted hemothorax after penetrating gunshot wounds to the chest were achieved with its earliest possible detection in cases of video-assisted thoracoscopic evacuation in the range of 3–7 days. Performing sanation videothoracoscopy at a later date (more than 7 days) was associated with an increase in the volume of surgical intervention (lung decortication, induction of chemical pleurodesis), which significantly increased the duration of treatment of the wounded at the stage of specialized medical care by 2 times.

1. Bryusov PG, Kuritsyn AN, Urazovsky NYu. Surgical videothoracoscopy for gunshot wounds of the chest. Military Medical Journal. 1996; 12: 65-69 (In Russ.)

2. Bisenkov LN. Surgery of gunshot wounds of the chest: A guide for doctors. St. Petersburg: Hippocrates, 2000. 312 p. (In Russ.)

3. Levchuk AL, Rybakov SM, Koptev EM. Diagnostics and treatment of clotted hemothorax after gunshot injury. Military Medical Journal. 1996; 9: 26-29. (In Russ.)

4. Zaitsev DA, Movchan KN, Lishenko VV, et al. Use of thoracoscopy under local anesthesia and proteolytic enzymes in the elimination of clotted hemothorax. Bulletin of SPU Medicine. 2018; 3(3): 271-279. (In Russ.)

5. Voskresenskiy OV, Danielyan ShN, Abakumov MM. Videothoracoscopy for clotted hemothorax in victims with penetrating chest wounds. Emergency medical care. 2015; 5: 14-19. (In Russ.)

6. Levchuk AL. Characteristics of penetrating gunshot wounds to the chest received during combat operations. Military Medical Journal. 1996; 9: 23-26. (In Russ.)

7. Ivchenko DP, Zhestkov KG, Perekhodov SN. Surgery of chest wounds. M.: Eksmo, 2024. 222 p. (In Russ.)

8. Kitaev VM, Akhiev MI, Badurov BSh. X-ray diagnostics of gunshot wounds and chest injuries. M.: MEDpress-inform, 2024. 110 p. (In Russ.)