Pediatric Hemothorax

  • Etiology:
    — Blood in pleural space
    — Common causes are trauma and anticoagulation
  • Imaging CXR:
    — Meniscus sign on AP view
    — May be free flowing on decubitus view
  • Imaging US: Complex fluid in pleural space
  • DDX: Pleural effusion, empyema
  • Complications: Can become loculated and difficult to drain via chest tube
  • Treatment: Chest tube
  • Clinical:

Radiology Cases of Hemothorax Due to Extracorporeal Membrane Oxygenation

US of hemothorax in patient on extracorporeal membrane oxygenation (ECMO)
Sagittal and transverse US of the right chest shows a complex fluid collection in the right pleural space.
US of hemothorax as a complication of extracorporeal membrane oxygenation
CXR AP (above) shows correct position of the ECMO venous-venous catheter tip near the junction of the right atrium and the inferior vena cava. There are bilateral pleural effusions most prominently seen in the apex of the lungs. Transverse US of the right hemithorax (below left) shows echogenic pleural fluid lateral to the atelectatic right lower lobe. Sagittal US of the left hemithorax (below right) shows echogenic pleural fluid inferior to the atelectatic left lower lobe and superior to the spleen.