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Iatrogenic haemothorax — SCE Respiratory MCQ

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HardPleural DiseaseIatrogenic haemothoraxSCE Respiratory

A 49-year-old man develops dyspnoea after attempted right subclavian venous access. CXR shows a moderate pleural effusion; pleural aspirate has haematocrit 0.24 and peripheral blood haematocrit is 0.34. He is tachycardic and his haemoglobin has fallen by 28 g/L. What is the most appropriate management?

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Correct answer: D — Drain the haemothorax and obtain urgent procedural review

Pleural fluid haematocrit exceeding 50% of peripheral blood confirms haemothorax, and haemodynamic change after central line attempt requires urgent drainage and procedural control. Treating as a transudate or observing misses ongoing blood loss. Fibrinolytics and diuretics do not address acute iatrogenic bleeding.

Reference: BTS Pleural Procedures Statement; BTS Pleural Disease Guideline 2023: https://www.brit-thoracic.org.uk/clinical-resources/guidelines/pleural-disease/