Diagnosis and treatment of coagulated hemothorax after a gunshot injury to the chest at the stage of specialized care

Relevance: Coagulated hemothorax is the most common complication of penetrating gunshot wounds to the chest, requiring surgical treatment in most patients. Materials and methods: From 2023 to 2024, videothoracoscopy was performed on 43 victims with complications of penetrating gunshot wounds to the chest. Coagulated hemothorax was detected in 39 patients (90.7%). Results: Spiral computed tomography with Hounsfield lesion density testing has the highest diagnostic capabilities for this pathology (specificity – 93% and sensitivity – 100%). It was established that the main cause of this complication was incorrect installation and inadequate function of pleural drainage. Coagulated hemothorax developed after pleural drainage and primary surgical treatment in 33 victims (76.7%), after atypical thoracotomy – in 4 wounded (10.3%) and in 2 patients (5.1%) after typical thoracotomy. The average interval between surgeries was 7.4±6 days. Conclusion. The best results of treating clotted hemothorax after penetrating gunshot wounds to the chest were achieved with its earliest possible detection in cases of video-assisted thoracoscopic evacuation in the range of 3–7 days. Performing sanation videothoracoscopy at a later date (more than 7 days) was associated with an increase in the volume of surgical intervention (lung decortication, induction of chemical pleurodesis), which significantly increased the duration of treatment of the wounded at the stage of specialized medical care by 2 times.