Role of Pleural Fluid Attenuation Value on CT as a Diagnostic Tool in Traumatic Hemothorax

Hemothorax; Traumatic Clinical Trial

Official title:

Role of Pleural Fluid Attenuation Value Measurement on Computed Tomography as a Diagnostic Tool for Hemothorax in Traumatic Patients

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT04098185
• Other study ID #: CT in traumatic hemothorax
• Status: Not yet recruiting
• Start date: December 1, 2019
• Est. completion date: January 1, 2021

Study information

• Verified date: September 2019
• Source: Assiut University
• Contact: Ghada Abdelazem Abdelbary, Dr
• Phone: 00201098815249
• Email: khalid.kamal1987[@]yahoo.com
• Is FDA regulated: No
• Study type: Observational

Clinical Trial Summary

To define the potential role of pleural fluid attenuation value determined on computed tomography (CT) for diagnosis of traumatic hemothorax and differentiate it from other pleural effusion.

Description:

Hemothorax is defined as blood accumulation in the pleural space. It is a consequence of blunt trauma in 90% of cases. Hemothorax due to blunt trauma mechanisms e.g traffic accidents,sport accidents and falls are among the commonest injuries of the chest. It is manifested in 30-50% of chest trauma cases. In such cases, bleeding might be caused by damage to pulmonary parenchyma or intercostal arteries associated with or without rib fractures and other chest wall tissue injuries including parietal pleura or other thoracic structures. Although other pleural effusion types may also manifest such as chylothorax in case of chest trauma, however fluid detected in pleural space is usually considered blood unless proven not to be. Despite the clinical and radiological findings provide important data about the content of pleural cavity, however tube thoracostomy and diagnostic thoracocentesis are still required to relieve pressure and characterize the fluid. Tube thoracostomy is an invasive procedure which can lead to immediate procedural injuries, infections and pain which can contribute to respiratory failure in patients with chest wall injury. Although needle thoracocentesis is less invasive than tube thoracostomy, however it carries small but definitive risks such as pneumothorax, bleeding and chest wall hematoma. Since hemothorax is a potentially life threatening, it must be diagnosed quickly and accurately and all these unnecessary complications should be avoided. Chest computed tomography [CT] has been accepted as the gold standard imaging study for evaluating chest trauma and usually performed in patients with grossly severe chest trauma, as it helps to detect even small hemothorax.

CT can also allow for more advanced characterization of pleural fluid and distinguish hemothorax from any other types of effusion by means of scaling Hounsfield units as in literature, any attenuation value for pleural fluid between 35 and 70 HU is considered typically blood, so it can be considered as an important non-invasive diagnostic tool for diagnosis of hemothorax in traumatic patients.

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 100
• Est. completion date: January 1, 2021
• Est. primary completion date: December 1, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 75 Years

Eligibility

Inclusion Criteria:

• All patients above 18 years old

• History of blunt chest trauma

• Having mild to moderate effusion

• CT chest within 1st 24 hours of trauma

• Patients underwent tube thoracostomy or thoracocentesis

Exclusion Criteria:

• Patients in need of emergency transfer to surgery.

• Hemodynamically stable.

• Patients with penetrating trauma.

• Patients with no need for tube thoracostomy or thoracocentesis.

• Patients with minimal effusion.

• Pregnant females.

Related Conditions & MeSH terms

• Hemothorax
• Hemothorax; Traumatic

Intervention

Device:
• CT
Non-contrast Multidetector Computed Tomography will be done for all patients using 16 or 64 MDCT scanner. Standard scanning parameters of chest CT are used with slice thickness 5 mm, 120kv and automated mAs.The evaluation of pleural effusion attenuation will be done using the average measure of 3 slices with greatest amount of fluid. A region of interest (ROI) is placed for measurement of Hounsfield unit values, where pleural fluid is observed to be most intense and the density values of the pleural fluid and of the aorta are quantitatively measured in the same section with taking care not to involve adjacent ribs, lung parenchyma or areas of pleural thickening.

Locations

Country	Name	City	State
n/a

Sponsors (1)

Lead Sponsor	Collaborator
Assiut University

References & Publications (12)

Bolus D, Morgan D, Berland L. Effective use of the Hounsfield unit in the age of variable energy CT. Abdom Radiol (NY). 2017 Mar;42(3):766-771. doi: 10.1007/s00261-017-1052-4. — View Citation

Cummings KW, Javidan-Nejad C, Bhalla S. Multidetector computed tomography of nonosseous thoracic trauma. Semin Roentgenol. 2014 Apr;49(2):134-42. doi: 10.1053/j.ro.2014.01.002. Epub 2014 Jan 28. Review. — View Citation

Gordon CE, Feller-Kopman D, Balk EM, Smetana GW. Pneumothorax following thoracentesis: a systematic review and meta-analysis. Arch Intern Med. 2010 Feb 22;170(4):332-9. doi: 10.1001/archinternmed.2009.548. Review. — View Citation

Hooper C, Lee YC, Maskell N; BTS Pleural Guideline Group. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii4-17. doi: 10.1136/thx.2010.136978. — View Citation

Kaewlai R, Avery LL, Asrani AV, Novelline RA. Multidetector CT of blunt thoracic trauma. Radiographics. 2008 Oct;28(6):1555-70. doi: 10.1148/rg.286085510. Review. — View Citation

Liu F, Huang YC, Ng YB, Liang JH. Differentiatepleural effusion from hemothorax after bluntchest trauma; comparison of computed tomography attenuation values. Journal of AcuteMedicine 2016; 6: 1-6.

Meyer DM. Hemothorax related to trauma. Thorac Surg Clin. 2007 Feb;17(1):47-55. Review. — View Citation

Miller LA. Chest wall, lung, and pleural space trauma. Radiol Clin North Am. 2006 Mar;44(2):213-24, viii. Review. — View Citation

Mirvis SE. Imaging of acute thoracic injury: the advent of MDCT screening. Semin Ultrasound CT MR. 2005 Oct;26(5):305-31. Review. — View Citation

Romero M, Bächler P. Pseudo-hemothorax at computed tomography due to residual contrast media. Clin Imaging. 2014 May-Jun;38(3):333-5. doi: 10.1016/j.clinimag.2014.01.004. Epub 2014 Jan 16. — View Citation

Sangster GP, González-Beicos A, Carbo AI, Heldmann MG, Ibrahim H, Carrascosa P, Nazar M, D'Agostino HB. Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol. 2007 Oct;14(5):297-310. Epub 2007 Jul 11. Review. — View Citation

Sridhar S, Raptis C, Bhalla S. Imaging of Blunt Thoracic Trauma. Semin Roentgenol. 2016 Jul;51(3):203-14. doi: 10.1053/j.ro.2015.12.002. Epub 2015 Dec 18. Review. — View Citation

* Note: There are 12 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Role of pleural fluid attenuation value measurement on CT as a diagnostic tool for traumatic hemothorax	Measurements of pleural effusion attenuation value on CT to diagnose traumatic hemothorax and differentiate it from other types of pleural effusion.	from 1 December 2019 to 1 December 2020