RADIOLOGIC-DIAGNOSIS OF HEMOTHORAX DURING NEONATAL EXTRACORPOREAL LIFE-SUPPORT

The recognition of a significant hemothorax by chest radiography can b e difficult during extracorporeal life support (ECLS) because diffuse pulmonary opacification is typically present. Five newborns who develo ped hemothoraces after repair of a congenital diaphragmatic hernia whi le on ECLS were evaluated. The presence of a clinically important hemo thorax was suspected when a shift in the position of the ECLS venous c annula was noted on comparable chest films. Four patients required ope rative evacuation of hematomas and one responded successfully to sucti on-catheter evacuation of clot through a chest tube. All patients impr oved in their clinical status without recurrence 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. Awaren ess of this finding may allow early recognition and appropriate interv ention.