A 64 y/o M presents to the ED after being ejected off his motorcycle as the car in front of him stopped abruptly. He denies LOC or amnesia, not on blood thinners, but complaining of dyspnea. Initial VS are as follows: BP 140/90, HR 105, SpO2 84% on RA, Temp 34C, RR 22. On arrival, you obtain a STAT CXR, which is shown below. What's the diagnosis? (scroll down for answer)

Answer: Hemothorax!

Ultrasound: PTX vs Hemothorax

• PTX will show lack of lung sliding

• Hemothorax will show fluid in the dependent portion of the chest

DDx for hemithorax/unilateral whiteout 

Trachea TOWARDS white side:

• Atelectasis

• Pneumonectomy

Trachea Central:

• Pneumonia

• ARDS

• Chest wall mass

Trachea AWAY FROM white side:

• Pleural Effusion/Hemothorax

• Diaphragmatic Hernia

• Diaphragmatic Rupture

• Lung Mass

Treatment: Placement of surgical chest tube! 

See this link for a great review of the procedure. 

‘Traditional’ Indications for Thoracotomy (based on chest tube output):

• A) 1L or greater at insertion, or

• B) ongoing bleeding of 150 to 200 mL/hr for 2-4 hours

references: Tintinalli, JE. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 8th ed. New York, NY: McGraw-Hill Education LLC, 2016.