For some people surgery, a thoracotomy open chest surgery in contrast to minimally invasive surgery is needed to get to the source and control the bleeding, especially in the setting of large hemothorax or when the source of the bleeding is uncertain. All the published cases of extramedullary foci bleeding deal with the pleural cavity; the reason is not clear but it may be related to preferential localisation or specific tissue structures rendering them vulnerable to rupture due to thoracic respiratory movements Help to maintain airway clearance.
After the tube thoracostomy has been performed, a CXR should be repeated in order to identify the position of the chest tube, to reveal other intrathoracic pathology and to confirm whether the collection of blood within the pleural cavity has been fully drained.
In addition, tumor dissection from adjacent structures is required. It is the procedure of choice in critical situations and if diagnostic tests suggest injury to the great vessels and the heart. Help to improve ventilation, oxygenation and to re-inflate atelactic lung areas.
Management of patient with vascular EDS is difficult because there is no specific treatment. This entity can affect any organ system, especially connective, nervous and vascular tissues, and is characterized by skin tumors and abnormal cutaneous pigmentation.
This may be indicated if there is blood loss via the chest drain over 1, ml in 24 h or ml per hour during several successive hours and the need for repeated blood transfusions to maintain haemodynamic stability. There may be a higher risk for those participating in sports or other activities that may cause repetitive blunt impact to the chest, abdomen, or shoulders.
The management is related to the patient stability Figure 1.