Many patients with a penetrating injury to the thorax can be managed conservatively. However, certain injuries make thoracotomy necessary.



(1) This list refers to non-cardiac injuries. A cardiac injury usually requires immediate surgery.

(2) Fiberoptic thoracoscopy is less traumatic and can be useful in borderline cases.


Indications for thoracotomy:

(1) vascular injury to the aorta, innominate, subclavian or carotid artery(ies)

(2) vascular injury at the thoracic outlet

(3) hilar (central pulmonary) injury

(4) injury to bronchus, trachea or esophagus (as demonstrated by endoscopy or imaging studies)

(5) possible traverse of the mediastinum (may require diagnostic studies)

(6) massive air leak

(7) massively clotted hemothorax

(8) initial bleeding > 20 mL per kg body weight

(9) blood loss > 250 mL per hour for >= 2 hours



• Blood loss refers to bleeding from the thoracic injuries.

• Drainage from a chest tube obstructed by clotted blood may underestimate the blood loss.


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