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Abstract Haemothorax is an accumulation of blood in the pleural space. Retained haemothorax refers to blood that cannot be drained from the pleural cavity and is associated with an increased risk of empyema and fibrothorax often necessitating surgical evacuation. We describe our experience of using intrapleural fibrinolytic therapy in three patients with different bleeding risk and acute non‐traumatic retained haemothorax. The first was a 41‐year‐old female with disseminated Candida guilliermondii sepsis and an iatrogenic haemothorax, second was a 48‐year‐old female with transfusion‐dependent acute myeloid leukaemia and spontaneous haemothorax, and the third was a 72‐year‐old female with spontaneous haemothorax from newly diagnosed lung cancer. All patients received one to two doses of intrapleural alteplase without any bleeding complications and resolution of retained haemothorax. This case series demonstrates the successful application and safety of this approach as an alternative to surgery in a well‐resourced environment with close monitoring and ready access to blood transfusion.

Haemothorax is an accumulation of blood in the pleural space. Retained haemothorax refers to blood that cannot be drained from the pleural cavity and is associated with an increased risk of empyema and fibrothorax often necessitating surgical evacuation. We describe our experience of using intrapleural fibrinolytic therapy in three patients with different bleeding risk and acute non‐traumatic retained haemothorax. The first was a 41‐year‐old female with disseminated Candida guilliermondii sepsis and an iatrogenic haemothorax, second was a 48‐year‐old female with transfusion‐dependent acute myeloid leukaemia and spontaneous haemothorax, and the third was a 72‐year‐old female with spontaneous haemothorax from newly diagnosed lung cancer. All patients received one to two doses of intrapleural alteplase without any bleeding complications and resolution of retained haemothorax. This case series demonstrates the successful application and safety of this approach as an alternative to surgery in a well‐resourced environment with close monitoring and ready access to blood transfusion. [ABSTRACT FROM AUTHOR]

Background Post-traumatic residual haemothorax (RH) is common and carries significant morbidity. However, its optimal treatment is not clear. Aim The aim of this study was to find the extent of this problem and the choice of treatment between VATS and intra-pleural streptokinase instillation (IPSI). Material and methods This RCT, conducted over 18 months period, included all patients of chest trauma between 18 and 70 years of age, admitted with haemothorax or haemopneumothorax requiring inter-costal drain (ICD) insertion. 154 events of haemothorax/haemopneumothorax requiring ICD insertion were enrolled. RH was seen in 48 (31%) patients: 13 patients were excluded from RCT after refusal for treatment. Seventeen (49%) patients of remaining 35 RH cases were randomized to IPSI group and 18 (51%) patients were randomized to VATS group. The outcome parameters were resolution of RH and treatment related complications. Results RH resolved equally well in VATS and IPSI group [13 patients (72%) versus 12 patients (71%), respectively; continuity-adjusted p = 1]. Morbidity wise no difference ( p -value 0.529) was seen in the two groups. Conclusion Post-traumatic RH is seen in 1/3rd patients and is equally well treated by VATS and IPSI. [ABSTRACT FROM AUTHOR]