Radiologic diagnosis of hemothorax during neonatal extracorporeal life support

Abstract

The recognition of a significant hemothorax by chest radiography can be difficult during extracorporeal life support (ECLS) because diffuse pulmonary opacification is typically present. Five newborns who developed he- mothoraces after repair of a congenital diaphragmatic hernia while on ECLS were evaluated. The presence of a clinically important hemothorax was suspected when a shift in the position of the ECLS venous cannula was noted on comparable chest films. Four patients required operative evacuation of hematomas and one responded successfully to suction-catheter evacuation of clot through a chest tube. All patients improved in their clinical status without re- currence of the hemothorax. A shift in the position of the ECLS venous cannula may be a radiographic clue that a significant hemothorax exists in newborns on ECLS. Awareness of this finding may allow early recognition and appropriate intervention. operative interventions that may have occurred prior to or during ECLS. The radiologic recognition of significant bleeding into the thoracic cavity can be quite difficult be- cause diffuse pulmonary opacification is typically present during ECLS (5, 6). We recently treated five infants who developed bleeding into the thoracic cavity following op- erative procedures for a CDH while on ECLS. In each case, displacement of the intrathoracic ECLS venous cannula was the initial radiographic clue that led to prompt diag- nosis of the unilateral hemothorax and successful surgical treatment.