RICE & MICE: Hemothorax

Lindros, still looking pale, just days after he suffered a hemothorax. From: http://www.mcall.com/sports/hockey/flyers/mc-pictures-eric-lindros-through-the-years-201-010,0,1423133.photo

Hemo-what? Hemothorax.

Hemo- means blood and thorax means chest, so literally blood in the chest. More specifically, a hemothorax is a collection of blood in the pleural cavity, the space between the chest wall and the lung.

Thirteen years ago, on April 1, 1999, Eric Lindros suffered one of the more bizarre and serious injuries that we will see in hockey. The Flyers were in Nashville, playing and battling against the Nashville Predators. Little did they know, in the wee hours of the next morning, Lindros would be battling for his life. Nobody could ever pinpoint which check caused the problem, but nobody will ever forget the end result or the consequences it would have on the relationship between Eric Lindros and the Flyers organization.

Hemothorax. Borrowed from: health.allrefer.com

When Lindros complained of rib pain in the 3rd period of the game, it was thought that he had bruised a rib, which is a relatively common injury in athletes of contact sports and rarely a a serious injury.

He received treatment after the game from team trainer John Worley and joined teammates for a late dinner before returning to the hotel because he didn’t feel well. What he didn’t realize was that he was slowly leaking blood into the pleural space of his right lung.

When blood leaks into this space, it is called a hemothorax and is usually the result of blunt force traumas, such as falls and car accidents, or penetrating injuries, like stab or gunshot wounds. Damage to the tissues or bones of the chest wall or damage to the lung or blood vessels around the lung is usually the cause of the bleeding.

Lindros returned to his hotel room and was in bed when his roommate, Keith Jones, returned. A few hours later, Jones woke up and found Lindros nursing his injury in the tub and in much more pain.

Jones tried to call Worley in his hotel room but got no answer. Worley was at the hospital with Mark Recchi, who suffered a concussion that game and and needed more testing, including a CT scan of his head.

Worley returned to the hotel at around 7 am; around the same time that Jones woke again to find Lindros still in the tub, very pale and short of breath. When he finally got in touch with Worley, Lindros was in severe pain. Worley made arrangements for Recchi to fly home that day and after talking to one of the team doctors, thought he could send Lindros back as well.

Chest tube. Borrowed from: health.allrefer.com

Nearly 3 hours later, Lindros deteriorated even more. It was evident that he was in shock and was rushed to a nearby hospital, where doctors had to perform an emergency procedure to drain the blood from his chest and re-inflate his collapsed lung. So much blood had leaked into the pleural space, that his lung could no longer expand against the pressure and collapsed.

 

Before (left) and After (right) draining of hemothorax. Borrowed from health.allrefer.com

Here is where I pause and tell you I’m not going to get into the controversial topic of what should have been done at the time or how the situation should have been handled, but I will say that while athletic trainers are very knowledgeable, they are not trained to diagnose serious problems like this. They can treat bruises and sprains and aches and pains, yet they should be able to recognize signs of shock as all trainers receive first aid training.

When Lindros suffered what is assumed to be a lung contusion (bruised lung), the bleeding was slow and steady and the seriousness of the injury was probably not initially evident. It was reported that nearly three liters of blood leaked into Eric’s chest — that’s one and a half two liter bottles of soda — which is around half of the total volume of blood in his body. In an average man, losing even 1 liter of blood may cause early symptoms of shock, which include shortness of breath, rapid breaths, rapid heartbeat and low blood pressure. As the bleeding progresses, more significant signs of shock develop without any obvious signs of bleeding.

Right side hemothorax, caused by a bullet wound (bullet is circled). Borrowed from www.learningradiology.com

Most times, a hemothorax can be detected with a simple chest xray, like the one above.  The treatment generally consists of draining the blood out of the area, by making an incision and inserting a tube into the space to evacuate the blood. It’s a very unpleasant, but often lifesaving procedure. Draining the hemothorax will help revers the respiratory compromise, however if there is substantial blood loss, transfusion may be necessary to restore the blood volume to an adequate level.

When more than one liter of blood is drained from a hemothorax, surgical exploration is usually performed to detect and correct the source of bleeding, since sometimes a tear in blood vessels can be the culprit. The chest tube stays in place and is maintained on underwater seal suction, and the volume of drainage and air leak are noted and recorded daily. When drainage from the chest is less than 100 mL in 24 hours, the tube can be removed.

Complications of hemothorax, include residual clot, infected collections, and trapped lung, require additional treatment and, most often, surgical intervention. A residual clot and fluid is just what Lindros ended up with a week after the initial injury. He was still having some shortness of breath upon his return to Philadelphia and and underwent video thorascopy to remove the residual clot. Lindros did recovery fully from the hemothorax, however the relationship between the Flyers organization and the Lindros family is still somewhat scarred from the experience.

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