Talk:Hemothorax

Preparing for a return to FAC

Hi 4thfile4thrank, I saw Wikipedia:Featured article candidates/Hemothorax/archive1 got archived fairly quickly, but hopefully with a bit of teamwork/polish we can get it back to FAC fairly quickly. I'm hoping to have time to look over the article later this evening, but in the meantime I've pasted Spicy and SandyGeorgia's comments below so we can make a to-do list of sorts and discuss improvements here. Looking forward to the read! Ajpolino (talk) 21:10, 5 November 2020 (UTC)

Comments from FAC#1

Commenting because I was pinged. I am sick in bed, and hopped up on cold medication, and not in a good position to do a full review, but I can see several issues just on a cursory look at the article. Are emsworld.com, fpnotebook.com, symptoma.com, rn.com MEDRS sources (let alone high-quality MEDRS sources)? StatPearls articles are used pretty heavily, these have been discussed on WT:MED a few times (search the archives) and the general feeling is that they may be ok for basic information but they are not great sources overall. Several sources are from the 80s, 90s, and early 2000s (see WP:MEDDATE); older sources can be ok for uncontroversial info that has not changed much over the years, but the number of old sources here is concerning. There are some instances where citations are missing at the end of paragraphs.

On comprehensiveness - the epidemiology section only provides statistics for the US; I'm sure hemothorax occurs in other countries as well. Is there anything on history? Who was the first to describe hemothorax, how has treatment and diagnosis changed over the years, etc... There are several places in the article where technical terms should be explained or replaced with simpler alternatives (no lay reader is going to know what "fulminant" means)... some other prose issues. This is a good start, but I agree with Sandy that it will need substantial work to reach FA status, which would best be done outside the FAC process. There are plenty of medical editors with FA experience who would be willing to work with you on this. Spicy (talk) 18:49, 5 November 2020 (UTC)

@Spicy: I don't see any sources showing the info. In rare diseases like thins, not all the info in the world is available. 4thfile4thrank {talk} :? 18:59, 5 November 2020 (UTC)

On the easily fixed technical matters:

• The images need considerable cleanup to address MOS:SANDWICH and MOS:CAPTIONS
• "Additional images" is not a section per WP:LAYOUT ... those should be provided via a commons cat
• There is not a consistent citation style. Per WP:CITEVAR, the article had established the Diberri/Boghog format, but several other styles have been introduced.
• Many of the sources are (as Spicy mentioned) not at FA standard ... it is OK to occasionally use StatPearls for very basic info, but it is used a lot here, along with other odd websites.
• Books and journal articles don't need accessdates.
• The See also section needs attention. FAs should be comprehensive, meaning it is rare for there to be articles mentioned in See also that aren't already worked in to the body of the artile, explaining the relationship.
• One-sentence, stubby sections are best avoided.
• See WP:CITATION OVERKILL, and potentially surgery in the form of a thoracotomy or video-assisted thoracoscopic surgery (VATS) to prevent further bleeding.[7][19][12][8][25]
• Citations should be placed in ascending order ... by aortic rupture are often fatal.[8][4]
• Some attention to Wikilinking is needed.
• I will hold off on prose commentary because it makes little sense to work on prose while there are sourcing concerns. This is just a small list of easy things to address. The Boghog/Diberri tool for formatting citations from a PMID is here. SandyGeorgia (Talk) 19:42, 5 November 2020 (UTC)

Post-FAC comments

4thfile4thrank agree with Ajpolino, and here to help. The advantage of working off FAC is that we don't have the pressure of worrying about not clogging the FAC with too many nitpicks, which then discourages other editors from engaging. I am fully on board to help you with this, but am a bit busy over the next few days ... good luck here! Best regards, SandyGeorgia (Talk) 23:19, 5 November 2020 (UTC)

Just a couple of comments as I begin reading about hemothorax:

• If I'm understanding correctly (always questionable), can it be clarified in the Signs and symptoms section that a clinician is often suspecting hemothorax not because someone reports chest pain and their side makes a dull sound when tapped, but rather because the patient had some obvious chest trauma? Perhaps you could organize this section to first mention that hemothorax is typically a result of trauma, and here are the signs on top of that. Then mention the signs & symptoms for hemothorax independent of trauma? I'm not wedded to that order, I just feel the section currently gives a weird impression of what would actually make one suspect hemothorax (though perhaps I'm just wrong on that).
• On a similar note, in the interest of balance, if most hemothorax is due to trauma, is there anything else that can be said in the Causes#Traumatic section? It's a bit underwhelming as is.
• We typically try to write encyclopedia articles that describe but do not instruct. Several times, the Management section instructs the reader how to manage hemothorax instead of describing the management of hemothorax (e.g. Tubes should be removed...). Since this is a free encyclopedia and not a clinical manual, we usually prefer to attribute treatment guidelines to an authority (e.g. "The American College of Pulmonologists recommends... "). Or – if you can't find such a recommendation to follow – you can just describe current practice as the sources do (e.g. "Drainage tubes are typically removed..."). For an example, you can see the recently promoted FA Dementia_with_Lewy_bodies#Management, where the word "should" is only used once, with a direct attribution.
• Sources - Basically what Spicy and Sandy said above. Medicine changes, so you want to use the highest quality, most recent sources available to you. The good news is, it looks like this is topic that much is written about. I see several recent reviews on topics in this universe including [1], [2], and [3]. I thought maybe [4] would allow you to start an "Other animals" section, but I don't have access to the article so I can't tell. Perhaps you or another pagewatcher can check? Also if you'd like more drainage pictures, I noticed this article with lots of chest imaging is available under a compatible license, so we can bring in any pictures if you see some you like (I didn't really read it, just saw it's called "a pictorial review" so no promises).

Anyway, those are my thoughts after skimming the article and a few reviews on the topic. I should have a moment to circle back to this in a few days. In the meantime, ping me if there's any way I can be useful. Best of luck! It's great to see another editor interested in improving medicine-related articles! Ajpolino (talk) 02:16, 6 November 2020 (UTC)

• I missed the recent FAC. (It was closed very soon after starting.) The article as a whole could do with some expansion to provide more details. Some of the references are starting to age a little. Overall, I think that the article could reach FA standard with a moderate amount of effort. I am happy to help with this. Axl ¤ [Talk] 13:05, 6 November 2020 (UTC)

• Others have mentioned many of the points I would put. I'm not sure the division in Causes (Trauma, Iatrogenic, Non-traumatic) is working. The iatrogenic causes is still trauma, albeit caused by a doctor! And the non-traumatic section mentions minor trauma + anticoagulant/bleeding-disorder, which is still trauma. Perhaps the second section should be "Spontaneous". I'd also expect that section to have a lead sentence or so, rather than jump straight into sub-headings. Is "Mechanisms" the best title for the content within it? -- Colin°^Talk 18:27, 6 November 2020 (UTC)

These three divisions are the categories listed in Light's Pleural Diseases (6th edition, 2013). Boersma states that the primary cause is trauma to the chest, while iatrogenous and spontaneous haemothoraces occur less often. Axl ¤ [Talk] 00:06, 8 November 2020 (UTC)

Colin, 1) I moved minor trauma + anticoagulant/bleeding-disorder into traumatic where it belonged. 2) I see either spontaneous or non-traumatic as equally reasonable. 3) It is fairly standard for physicians, insurers, and the federal government to separate health care provider (HCP) induced trauma or other HCP induced misadventures from those not caused by HCPs. Wikipedia has a list of actions to be taken when an iatrogenic never events occur at Never_event#Recommended_actions_following_a_never_event. There are additional catagories at Hospital-acquired conditions. Thank you, Dan -- Memdmarti (talk) 05:09, 8 November 2020 (UTC)

That's an unhelpful edit, Memdmarti. Sources do not categorize anticoagulant/coagulopathy-associated haemothorax as "traumatic". It is particularly ironic that you also moved the reference for that statement, which is called "Etiology and management of spontaneous hemothorax". Axl ¤ [Talk] 11:56, 8 November 2020 (UTC)

Yes Axl, the title does not introduce their discussions which include trauma, coagulopathy, and iatrogenic causes. More specifically they distinguish trauma in the chest from spontaneous rupture of small vessels. The quotes are below. Do the quotes make the move more reasonable?

• Their definition is “Spontaneous haemothorax (SH) is a subcategory of haemothorax that involves the accumulation of blood within the pleural space in the absence of trauma or other causes.”
• They discuss “Haemothorax is a clinical entity that in most cases can be caused by trauma, coagulopathy, or iatrogenic causes through procedures such as central line insertion, thoracocentesis, pleural biopsies.”
• “Haemothorax may occur along with the administration of anticoagulant therapy. Blood can be collected in the pleural cavity either as a result of minimal trauma in the chest or spontaneous rupture of small vessels.” -- Memdmarti (talk) 18:11, 8 November 2020 (UTC)

-- Memdmarti (talk) 03:19, 9 November 2020 (UTC)

The reference is added in both sections. -- Memdmarti (talk) 03:28, 9 November 2020 (UTC)

Axl and Memdmarti, I think one confusion is the use of jargon (Trauma) and its translation (injury). Also the previous text "in response to very minor trauma" is now "spontaneous rupture of small vessels" -- the use of the word "trauma" previously was a contradiction with the text not being in the trauma section. Perhaps the authors of that book feel it important to separate trauma that happened outside of the hospital from that which happened from an accident inside the hospital, but I'm not sure our readers care about that distinction. Medically caused injury is still an injury. I don't know if it is possible to rewrite this to avoid the jargon term altogether, or at least to downplay its apparent importance. It seems the main distinction is whether it happened spontaneously or as a result of some injury to the person. -- Colin°^Talk 14:20, 9 November 2020 (UTC)

Memdmarti, no, the quotes don't make the statement more reasonable. Neither Light's Pleural Diseases nor Boersma characterize "minor trauma" associated with anticoagulation/coagulopathy as "traumatic haemothorax". Axl ¤ [Talk] 23:31, 9 November 2020 (UTC)

OK, please fix it from Light's and Boersma. Thank you, Dan -- Memdmarti (talk) 02:23, 10 November 2020 (UTC)

I have added an introductory sentence to the "Causes" section. If you guys are happy with this, I shall adjust the text of the subsections appropriately. Axl ¤ [Talk] 15:49, 10 November 2020 (UTC)

Naming style ref name=":8"

The reference naming style (using numbers like "ref name=":8"") interferes with my manually correcting references and noting page numbers. If there are no objections, I would like to change that naming style to a AuthorYearPage (when available) like ref name=Seligson2020p98. Note: Seligson (ref name=":8") does not have a page number and I have used an invented p98 as an example only. I also note that Seligson may need to be replaced as it is a StatPearls ref. If you want to wait until there is clarification of sources like StatPearls, emsworld.com, fpnotebook.com, symptoma.com, rn.com, please wave me off. Dan Memdmarti (talk) 18:17, 6 November 2020 (UTC)

Never mind. I created a key at User_talk:Memdmarti/sandbox/hemothorax#Key_for_ref_name=":xyz" -- Memdmarti (talk) 05:08, 8 November 2020 (UTC)

We still need to lose the dreadful :x citation naming style. It's nonsensical. Boersma2010 tells us what source :9 is, and that it's a dated source. SandyGeorgia (Talk) 16:39, 11 November 2020 (UTC)

Hi, SandyGeorgia! Do you want for them to be removed now or as I replace them with current refs? If now, please let me know how to identify when they were added so I can ask the user who posted them if that is OK. Thank you, Dan -- Memdmarti (talk) 00:55, 12 November 2020 (UTC)

You do not need permission here to fix nonsensical ref names that are entered by the software. SandyGeorgia (Talk) 01:28, 12 November 2020 (UTC)

ref name=":3, ":5 and ":6 are replaced by a 2020 PMC open access ref name= Dogrul2020p125 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296362/)

I will return tomorrow or later tonight. Dan -- Memdmarti (talk) 01:44, 12 November 2020 (UTC)

I will be back in a few days. Dan -- Memdmarti (talk) 04:57, 14 November 2020 (UTC)

Citation consistency and FAC rules

A couple of items to add:

4thfile4thrank I am unsure what you intended with this edit. You listed the author as G Wim, but you linked to an article with author Boersma; I corrected the citation to that article. El Servier is not a journal; it's a publisher. And to achieve FA status, articles must have a consistent citation style; the pre-existing style of this article was the Diberri format (Vancouver style authors). You can use this tool to generate a citation from a PMID or DOI. Also, that source is 2010; per WP:MEDDATE, is there a newer source? Also, because Wikipedia cannot give my medical advice, the word "should" is avoided.

A second thing that I just noticed is that PeaBrainC is the top contributor to this article. WP:FAC instructions remind that it is customary to consult top contributors before nominating at FAC. PeaBrainC, are you still involved here? SandyGeorgia (Talk) 16:28, 11 November 2020 (UTC)

@SandyGeorgia: PeabrainC is mostly inactive. Look at his contribs. He only makes occasional edits. 4thfile4thrank {talk} :? 16:30, 11 November 2020 (UTC)

What to do next? 4thfile4thrank {talk} :? 16:35, 11 November 2020 (UTC)

Maybe we can haul him back in here. At any rate, not to worry, as this article is nowhere near FA standard (or even GA standard yet), and by the time it is, PeaBrainC may no longer be the main editor. The FAC nominator is mainly expected to have and be familiar with all the sources. SandyGeorgia (Talk) 16:37, 11 November 2020 (UTC)

The reason I have so many issues is that I was semi-retired for one and a half year due to a lack of interest, and then focused on reverting vandalism. I do not have much experience in content creation anymore.4thfile4thrank {talk} :? 16:38, 11 November 2020 (UTC)

Not a problem; it's good to hear from you on talk. Could you please have a look at this section in edit mode so that you can properly thread responses by indenting to the next level? SandyGeorgia (Talk) 16:40, 11 November 2020 (UTC)

What to edit next? And how is it not GA standard is it is a GA and hasn't undergone major research yet? 4thfile4thrank {talk} :? 16:42, 11 November 2020 (UTC)

Wikipedia:Manual_of_Style/Images#Location Why was the edit reverted? 4thfile4thrank {talk} :? 16:43, 11 November 2020 (UTC)

That an article is assessed GA does not mean it is a GA; few editors ever submit faulty GAs for re-assessment. The essay that I wrote (as a former Coordinator of the WP:FAC page) at User:SandyGeorgia/Achieving excellence through featured content could be helpful. MOST images are placed on the right; placing this one on the left does not breach MOS. SandyGeorgia (Talk) 16:45, 11 November 2020 (UTC)

Hi @SandyGeorgia:, thanks for reaching out. 4thfile4thrank (or Steve, or Chessmaster, it's hard to keep up ;-) ) is right, I've not been very active over the last few months since starting a new job. I reviewed this article for GA assessment as nominated by 4thfile as my first GA review, receiving help from Axl and DavidnotMD. It was a drawn out process and I did a lot of rewriting myself in the end, hence the contribution stats. I'm sorry if you feel it's not up to GA standard, there was always going to more to do and maybe I made the wrong call about where to draw the line. Oh well, live and learn.

My own feeling is that at the time of nomination the article wasn't ready for FA. The flaws I had thought reasonable to slide for GA are clearly not acceptable for FA, and there had been minimal substantive change since I had last visited the article. I'm afraid I won't be able to take a big role in revising the article to FA standard, I'm sorry but I just don't have the time. Thanks, PeaBrainC (talk) 05:45, 12 November 2020 (UTC)

Great to hear from you, PeaBrainC, and hope you are a "good" busy. I did not mean to criticize your GA pass, as the standards are quite variable, and it does not really concern me if an article is passed GA or not, since the concept in my mind is not well defined. The only problem occurs when editors don't realize that passing GA has nothing to do with FAC readiness, and then find themselves disappointed at FAC. Best regards, SandyGeorgia (Talk) 15:46, 12 November 2020 (UTC)

Pre-FAC list

@SandyGeorgia: What more is needed to return to a decent FAC? Best regards, 4thfile4thrank {talk} :? 13:18, 25 November 2020 (UTC)

My general advice is at User:SandyGeorgia/Achieving excellence through featured content. Once the specific problems noted are cleaned up, it would be optimal to a) be sure you have clearance from several medical editors familiar with FA standards (eg, Colin, Graham Beards, Spicy and Ajpolino) and several also familiar with the specific topic (eg, Memdmarti, Axl and Peabrain). And then be sure to have a non-medical editor run through and do a jargon check for comprehensibility to the layperson. And check through all of the links and advice in the advice section and below at my essay. And once all of that is done, a copyedit should be performed (sample, especially when the blood's ability to clot is diminished as result either of anticoagulant medications or when there are bleeding disorders such as hemophilia).

HOWEVER. Before any of that can be done, the specific issues mentioned still need to be addressed:

• The most significant problem is sourcing. There is a link at the top of this page you can click that will take you here, where you will see multiple recent reviews that have not been consulted. See WP:WIAFA; it is expected that the article will have used the latest and highest quality sources, and that a comprehensive survey of the literature has been performed (eg, google books, google scholar, and PUBMED at least). It is likely that the article (and the missing pieces raised above) can be expanded and that many of the dated and marginal sources can be replaced (see WP:MEDRS and WP:MEDDATE).
• There is not a consistent citation style. Every citation needs to be checked. The Diberri/Boghog style with VANC authors is used in this article.
• The marginal sources have not been replaced. See Wikipedia:Wikipedia Signpost/2008-06-30/Dispatches. As mentioned early on by Spicy, several of the sources used here are not adequate for medical content, and would not be accepted for an FA.
• As mentioned above, the See also section still needs attention. FAs are expected to be comprehensive, so there are rare exceptions to when something should be listed in See also rather than having already been covered in the article.
• I already mentioned that books and articles do not need accessdates; along with the rest of the citation issues, this has not been addressed.  Done

• Not done, websites DO require accessdates: [5] Could you please thread your "done" checkmarks below my original comments? SandyGeorgia (Talk) 19:33, 1 December 2020 (UTC)

@SandyGeorgia: What is the difference between websites and articles? 4thfile4thrank (talk) 19:15, 2 December 2020 (UTC)

• Alt text should be added to the images.
• You can install this script and learn to distinguish hyphens from WP:ENDASHes and WP:EMDASHes. (I have run the script to correct the existing faulty hyphens.)  Already done
• You can install this script to see duplicate wikilinks; wikilinking still needs to be addressed. There are duplicate links as well as missing links (eg, we can't throw a word like iatrogenic at our readers without a link).  Done
• It is unclear if AJpolino's comments have been addressed. When prepping for FAC (or when at FAC), on should indicate what has been addressed and how ... preferably by also including a link.
• This google book search makes it appear that there are equine sources. See Wikipedia:Manual of Style/Medicine-related articles#Diseases or disorders or syndromes, Other animals.

@SandyGeorgia: Equine sources is  Done

I hope this gives you enough to work on for a while, and will be happy to re-review once all of this is addressed. SandyGeorgia (Talk) 17:19, 25 November 2020 (UTC)

Does anyone check this page

I rarely use article talk pages as I feel that no one checks wi without a ping. I plan to use it to document my improvements. Does anyone check this page? Steve M (talk) 01:47, 16 January 2021 (UTC)

@Steve M: (I just realized you are 4thfile), and @Ajpolino, Axl, Colin, Memdmarti, and Spicy: I have been meaning to comment that part of the problem has been that posts to my talk page are less effective for article improvement than posts to the article talk page, as others editors might not see them. It would be optimal to keep article queries here on article talk.

• I know you have several times asked about citation formatting, and I have answered with concerns about the actual sourcing, as opposed to the formatting. [6]
• I understand you are also inquiring about WP:MEDDATE; it is preferable for a Featured article to find sources, where possible, that are less than five years old, but that is not always possible.
• In his post above at 02:16, 6 November 2020, Ajpolino listed several recent reviews that have not all been incorporated.
• There are still some sources in the article that are not high quality as required by WP:WIAFA (eg Stat Pearls), so editors knowledgeable about the condition would need to opine whether those sources could be upgraded, or whether what they are citing is uncontroversial.
• There are still some citation formatting issues, samples only below.

• Salmon, Nadine; Lynch, Shelley; Muck, Kelly (2007-08-30). "Chest tube management" (PDF). No publisher, inconsistent author format, and unconvinced whether that is a high quality source.
• Mansour, Wissam; Samaha, Ghassan; El Bitar, Sandy; Esper, Ziad; Maroun, Rabih (2017-08-02). "Intercostal Artery Laceration: Rare Complication of Thoracentesis and Role of Ultrasound in Early Detection". Case Reports in Pulmonology. PMID, DOI, some identifier and it is a case report (see WP:MEDRS on the need to use secondary reviews).
• Zeiler, Jacob; Idell, Steven; Norwood, Scott; Cook, Alan (2020-1). Incorrect date formatting

That said, I am less concerned about inconsistent citation formatting, as I am willing to clean that up myself, than I am about whether or not the article is correctly sourced to recent high-quality reviews. Once that is sorted, I am more than willing to clean up the citations. The focus should be now on making sure that high quality sources are incorporated, including those listed above by Ajpolino, and that the article comprehensively covers each area as outlined at Wikipedia:Manual of Style/Medicine-related articles#Diseases or disorders or syndromes. For that purpose, keeping discussion here on talk, where content experts can weigh in, will be helpful.

And finally, once the sourcing and comprehensiveness are brought to WP:WIAFA standard, and the content has been reviewed by editors familiar with the topic (like Memdmarti and Axl), then there should be a thorough WP:MOS and prose check before re-approaching WP:FAC. Good progress is happening, but there's a bit more to do here, SandyGeorgia (Talk) 19:54, 16 January 2021 (UTC)

The horses section had no real choice but ancient books due to a lack of data on the topic and lack of access to literature. Is that acceptable? Steve M (talk) 20:01, 16 January 2021 (UTC)

SandyGeorgia, Are there any good sources that are not reviews? The textbook and a few articles exist, but are there any real sources that are good and are not reviews? Steve M (talk) 20:23, 16 January 2021 (UTC)

I believe Axl, Memdmarti and Ajpolino would be better able to answer that than I am, because a) content experts, and b) they have better access to medical libraries than I do. They could also indicate if they know if there are no more recent or more reliable sources than those used so far. SandyGeorgia (Talk) 20:38, 16 January 2021 (UTC)

FWIW, I'm watchlisting this page. (I more or less watchlist every page I edit). I had a look at a few recent edits and I have some concerns about close paraphrasing:

Source/diff	Article text	Source text
Source Diff	Physical examinations are nonspecific, but may show reduced lung sounds and heart sounds that are muffled and are heard over a wide area. Percussion can produce a dull area, but the procedure can be painful, especially in traumatic cases. Ultrasound is an effective method to detect and fluid in the pleural cavity.	Clinical examination is nonspecific, but may reveal decreased lung sound ventrally and muffled heart sounds that radiate over a wide area. Percussion may detect ventral areas of dullness, but this procedure may be painful, especially in cases of thoracic trauma. Thoracic ultrasonography is the method of choice to detect fluid in the chest cavity.
Source Diff	Vascular hemothorax is often caused by the rupture of the descending aorta. It initially occurs in the left pleural and mediastinal area due to the close vicinity of the pleural cavity. It is rare for a rupture of the thoracic aorta to result in a hemothorax, as the bleeding primarily occurs in the pericardial space.	Haemothorax of vascular origin is often due to a rupture of the descending thoracic aorta, initially in the mediastinal and left pleural space due to the proximity of the pleural cavity. Rupture of the thoracic aorta in the right pleural cavity is rare. The ascending thoracic aorta bleeds mainly into the pericardium.

I haven't checked to see if this is a problem throughout the article, but I think that these examples, at least, could use some rephrasing. Spicy (talk) 21:27, 16 January 2021 (UTC)

I haven't been watching this page (sorry!) but I'll add reviewing this to my to-do list, and will share my thoughts asap. Feel free to ping me if I seem to have forgotten! Ajpolino (talk) 23:07, 16 January 2021 (UTC)

Ajpolino, I will have nearly the entire day to expand on this article for the next two days. Please do so is you wish to. Steve M (talk) 00:38, 17 January 2021 (UTC)

• Should most of what is now listed at Hemothorax#See_also be incorporated into a Differential section of Diagnosis? SandyGeorgia (Talk) 23:42, 16 January 2021 (UTC)

  SandyGeorgia, I'll add them by the end of today. I do have an issue, though, with sourcing. What other sources exist than case report? There are a very limited handful of reviews, and I can't find many good ones. Steve M (talk) 23:50, 16 January 2021 (UTC)

  Have you searched books.google.com and scholar.google.com? SandyGeorgia (Talk) 23:51, 16 January 2021 (UTC)

  SandyGeorgia, Yes. I found a few reviews and Murray and Nadel, which are definitely good. What is the policy on case reports? Do they all need to be removed entirely? Steve M (talk) 00:06, 17 January 2021 (UTC)

  It is possible to use some primary sources in a limited way, but I do not know this content area well enough to opine on the uses of case reports: I would rely instead on Axl's or Memdmarti's feedback. SandyGeorgia (Talk) 00:22, 17 January 2021 (UTC)

Horses

There are several issues in this new section:

• On the image, see MOS:CAPTIONS (no punctuation on sentence fragments).
• The image discusses hemothorax caused by anti-coagulant poisoning; this is the first (and only) mention of same on the page, and there are no wikilinks.
• There are copyedit needs in the text, and the text rambles without apparent order or cohesion:

• worsen the bleeding. the prognosis depends on the underlying cause.
• and usually traumatic. It may result from trauma that involves the pleural, pleural, or rupture of large thoracic blood vessels.
• Ultrasound is an effective method to detect and fluid in the pleural cavity.
• In addition, in the case of open trauma to pulmonary rupture, broad spectrum antibiotics are given. ... what is "in addition" adding?
• but cases that develop pleuritis ... do cases develop?

Perhaps a good read-through and copyedit of that new section, with organized paragraphs, will help. Steve M, slow and steady wins the race when it comes to prepping an article for FAC. SandyGeorgia (Talk) 00:45, 17 January 2021 (UTC)

SandyGeorgia, I have done the copyedit. Please tell me if there are any issues remaining with the section. Steve M (talk) 16:35, 17 January 2021 (UTC)

Getting better, although again, the lung experts need to weigh in :)

• It can result from any injury that involves the pleural, intercostal, intervertebreal, pleural, cardiac,[39] or thoracic wall muscle. I don't know pleural is repeated (twice).
• Doublecheck that all the terms are wikilinked somewhere in the article, preferably close by.
• We still have anticoagulant poisoning mentioned only in the image caption, and nowhere else in the article.
• Shows by ? Bloody pleural effusions are shows by a swirling, hyperechoic pattern.
• However, especially in traumatic cases, percussion may be painful ... see overuse of however and User:John/however.
• Words like additionally and also are almost always redundant. Same for "in order to which is the same as "to".
• The prognosis depends a lot on the underlying cause ... "a lot on" is very informal.

SandyGeorgia (Talk) 17:43, 17 January 2021 (UTC)

SandyGeorgia, anticoagulants are mentioned in the traumatic subsection of the Causes section. Steve M (talk) 18:59, 17 January 2021 (UTC)

SandyGeorgia, All the other issues have been addressed. Steve M (talk) 19:07, 17 January 2021 (UTC)

Some thoughts

I'll reiterate that I knew nothing about hemothorax before you brought this page to FAC, so please feel free to dismiss any bad ideas I come up with. I'll post comments as I go, since I'm a slow reader and you indicated you may be available today. Feel free to respond to each inline, at the end, or not at all. Here we go:

Signs & symptoms

Collapsing extended feedback for talk page-reading ease

I still feel this section gives the odd impression that someone might feel breathless and think "oh my, maybe I have a hemothorax". Instead, my understanding (and I'm no trauma/lung expert) is that we'd suspect hemothorax because someone had a traumatic injury. Could this be made more clear? This review mentions distinct symptoms for a more severe "massive hemothorax" (1.5L of blood at drain placement!?) that can cause shock. Worth a sentence? This article (section "Traumatic hemothorax") also lays out more clinical signs of low blood volume associated with traumatic hemothorax. Sources - are mostly ok. In the past some folks have been unimpressed with StatPearls articles, but I can't remember the specific issue and the few I've read have been fine. Surely [7] (a 2006 case report) can be replaced by something more recent and authoritative. It's used to back-up a sentence that basically just says hemothorax can result in signs of low blood volume, which you should be able to find clearly stated elsewhere (perhaps the source I link above?). Ajpolino (talk) 19:13, 17 January 2021 (UTC) Ajpolino, I have addressed all the issues in this section. Steve M (talk) 20:18, 17 January 2021 (UTC) Causes One of the reviews I linked above gives much more detail into how trauma can result in hemothorax. I think it'd be worth including at least some of that detail here. The article currently divides hemothorax into traumatic, non-traumatic, and iatrogenic. I'm finding lots of sources discussing traumatic hemothorax, some discussing non-traumatic, and almost none discussing iatrogenic hemothorax. So perhaps the section should just be divided into traumatic and non-traumatic, and iatrogenic hemothorax could get a sentence or two in the non-traumatic subsection? Wikilink thoracentesis The nontraumatic section is a bit of disorienting read, as if the sentences could be rescrambled into another order and make just as much sense. Any ideas for how we could reorganize it with an aim to improve flow (that's a question for the whole group; I don't have a bold idea here)? On a similar note, it seems like catamenial haemothorax is covered in much more detail than other nontraumatic hemothoraces. The goal is for the section to reflect the importance (in sources, and theoretically in medicine) of each idea within. I suspect that would mean either slimming the endometriosis coverage a bit, or substantially beefing up the coverage of other non-traumatic causes? Sources - some are a bit old. If the material they cite is still up-to-date, I'm guessing we can find a more recent reference. Regarding the case reports: case reports can be easy to find, and often come with brief topical reviews, both of which are nice. But they also tend to describe unusual cases and (this is an opinion I have no factual basis for; it's just a suspicion I've developed over time) I suspect the topical reviews on case reports encounter less scrutiny during review than standalone reviews do. So where possible, I think it's best to refer to standalone reviews rather than case reports. That said, there's no strict prohibition on using the topical review in many case reports as a reference. But if I were you, I'd replace them. Ajpolino (talk) 19:59, 17 January 2021 (UTC) Ajpolino, is the section more organized now? Steve M (talk) 22:56, 17 January 2021 (UTC) Ajpolino, I replaced all the poor sources except for one where there is no better source. Steve M (talk) 13:48, 18 January 2021 (UTC) Mechanisms Hmmm I'm having trouble seeing how this section fits into the article as a whole. I suppose I'd suggest splitting it up? The first paragraph reads like a "Background" section. The second paragraph could mostly be description to beef up the Signs & symptoms section (where we already mention that many of the signs of hemothorax are signs of low blood volume). The last paragraph could probably go to Prognosis or Management, neither of which I've read yet, so I'm not sure where exactly to put it? Alternatively, you could keep the second paragraph and add more material to fill out this section. We typically use the Mechanisms section to expand on how the material in the Causes section leads to the disease. So perhaps more detail on how trauma (somewhat obvious), cancers, et al. lead to hemothorax? Sources - some of these sources are a bit old, though none of the old sources reference anything controversial. I don't have access to those textbooks, so no opinion on those. Ajpolino (talk) 20:28, 17 January 2021 (UTC) Ajpolino, All issues in this section have been addressed for now. Steve M (talk) 13:50, 18 January 2021 (UTC) Diagnosis [8] mentions a high sensitivity and specificity of diagnosing trauma hemopneumothorax by auscultation. May be worth a mention? which can be estimated by dividing the red blood cell count of the pleural fluid by 100,000. I've never heard of this before and I can't wrap my head around why this would work. The textbook cited doesn't provide any further details. Does anyone know if this is common? Is there a standard volume that fluid RBC counts are always reported in (i.e. do they assume it's the RBC count in 1 mL of pleural fluid?)? That's all I'll get to today! Will continue as soon as I can find a bit of time. Haven't had a chance to review your changes either. Sorry. Hope all is well. Ajpolino (talk) 00:38, 18 January 2021 (UTC)

• Hi, Steve M and SandyGeorgia. My personal favourite respiratory textbook is Fishman's Pulmonary Diseases and Disorders. For pleural diseases, Light's Pleural Diseases is the best. Regarding case reports, in general I am not keen on incorporating them into Wikipedia as sources. While they often have literature review summaries, these are not as authoritative as stand-alone review articles or textbooks. Axl ¤ [Talk] 21:20, 17 January 2021 (UTC)

  Axl, Is there any issue with subheadings for Iatrogenic, vascular, and Catamenial in the non-traumatic section? Steve M (talk) 22:49, 17 January 2021 (UTC)

  Axl, where would the background section go? Steve M (talk) 23:46, 17 January 2021 (UTC)

It is unclear to me that a separate subsection for "Catamenial" is justified. This is a rare type of non-traumatic haemothorax. The three references currently included are all specific for thoracic endometriosis rather than generic haemothorax. I shall try to find some information on the incidence of catamenial haemothorax.

WP:MEDMOS doesn't actually mention a "Background" section at all in disease articles. Nevertheless, in this article I think that it is reasonable to include a three-sentence background as we currently have, to provide readers with this basic anatomical information. In my opinion, this background section should be near the top of the article, immediately after the table of contents, and before "Signs and symptoms". Axl ¤ [Talk] 00:31, 18 January 2021 (UTC)

Axl, what article should the main article template point to in the Background section? Steve M (talk) 00:42, 18 January 2021 (UTC)

I think that "Pleural cavity" would be better than "Thoracic cavity". Axl ¤ [Talk] 01:49, 18 January 2021 (UTC)

I have changed it. Axl ¤ [Talk] 01:50, 18 January 2021 (UTC)

• Axl, should information be removed if the only sources are case reports? Steve M (talk) 03:49, 18 January 2021 (UTC)

Well, the first step should be to consider if the information is really worthy of being included in Wikipedia's article (i.e. even if you had a good-quality source). If it should, then look for better quality sources. If we can't find good sources, then try to get a consensus on whether the info is justified by the (case report) source. Each statement needs to be evaluated on its own. This is not a simple yes or no blanket answer. Axl ¤ [Talk] 11:35, 18 January 2021 (UTC)

Axl, is this worth uncluding despite primary sources? "It generally occurs acutely (within 24 hours of the procedure). Most cases caused by thoracentesis occur due to lacerations of the intercostal artery. The risk of this can be reduced if color doppler is used." I am unable to find any other sources that support it. Steve M (talk) 13:40, 18 January 2021 (UTC)

Ajpolino, for now, all the issues in this have been addressed. Steve M (talk) 21:00, 18 January 2021 (UTC)

Ajpolino, Light's pleural diseases, believe it or not, does contain the information that it is true. SO I readded it. Steve M (talk) 00:39, 19 January 2021 (UTC)

References

In my opinion, these statements and reference should not be included. I accept that the statements are probably true. However there is no indication of the proportion of iatrogenic haemothoraces that are caused by thoracentesis. (Actually the most common iatrogenic causes are central venous catheterization or translumbar aortography.) The source is specifically about thoracentesis, not haemothorax in general. Axl ¤ [Talk] 16:55, 18 January 2021 (UTC)

Steve M, do you have access to the books Axl mentions above at 21:20, 17 January 2021? It would seem those might be necessary in the attempt to produce a Featured article. SandyGeorgia (Talk) 16:59, 18 January 2021 (UTC)

SandyGeorgia, yes, I do. I will try inserting content in from those books, but I obviously cannot copy/paste text from the book here. Best, Steve M (talk) 17:54, 18 January 2021 (UTC)

SandyGeorgia, I have taken and paraphrased all information from the Fishman book. Steve M (talk) 20:48, 18 January 2021 (UTC)

There's not much information about haemothorax in Fishman: only two paragraphs and one table. (Oddly, there is a disproportionate emphasis on catamenial haemothorax.) Unsurprisingly, Light's textbook has much more information because it specializes in pleural diseases. Axl ¤ [Talk] 21:36, 18 January 2021 (UTC)

Axl, I'll check that too. Steve M (talk) 23:58, 18 January 2021 (UTC)

SandyGeorgia, I have finished taking info from both books. What next? Steve M (talk) 01:27, 19 January 2021 (UTC)

Are the See also items differential diagnoses? If so, they should be worked in. If not, why are they there? The relationship need to be explained or understood somewhere. Once content experts have reviewed the text and approved the sourcing, I would be willing to clean up the citation formatting to something consistent, but do not want to make that effort if others still have concerns about sourcing, content or prose. FAs take time :) SandyGeorgia (Talk) 01:30, 19 January 2021 (UTC)

No, they are not differential diagnoses. Cardiac tamponade is a potential complication (although it might be better described as a consequence of chest trauma rather than a complication of haemothorax). Haemopneumothorax is better characterized as a complication of pneumothorax, not of haemothorax. Pulmonary contusion and tension pneumothorax are typically consequences of chest injury.

In the "Causes", "Traumatic" subsection, it would be reasonable to add one sentence mentioning that other chest injuries can also occur in the setting of chest trauma. Haemopneumothorax is already mentioned in the "Nontraumatic" subsection. I don't think that this "See also" section is helpful. Axl ¤ [Talk] 11:54, 19 January 2021 (UTC)

Okay, I have added a sentence to the "Traumatic" subsection and deleted "See also". Axl ¤ [Talk] 12:07, 19 January 2021 (UTC)

Axl, I have added superior images for the surgery section. Is it possible that you check them for MOS-related issues? Steve M (talk) 18:57, 23 January 2021 (UTC)

SandyGeorgia, now that the See also section has been addressed, what is the best course of action for me? Steve M (talk) 20:56, 19 January 2021 (UTC)

Same. Wait for ajpolino, colin, axl, spicy, memdmarti to have time to review content, then I will clean up citations. People have lives and other commitments ... it takes time to produce an FA. SandyGeorgia (Talk) 21:13, 19 January 2021 (UTC)

• I've taken a crack at making the Background section more layperson friendly. Hopefully that is a bit more orienting to the non-physician/anatomist? Happy to hear any feedback, and please correct any errors. Ajpolino (talk) 22:54, 23 January 2021 (UTC)

  Ajpolino, I fixed a comma issue, but asides from that, it looks fine Steve M (talk) 01:02, 24 January 2021 (UTC)

• The first paragraph of Signs and symptoms is referenced to [9] which doesn't backup most of the material in that paragraph. Ajpolino (talk) 22:58, 23 January 2021 (UTC)

  Ajpolino, I deleted all the info there, as it was mostly a lot of WP:SYNTH that did not have possible sourcing. Steve M (talk) 01:03, 24 January 2021 (UTC)

• Hi Steve M, I'm slowly going through with a fine-toothed comb, so I'll continue to leave comments as I go from top-to-bottom. In the meantime, this article still has some sourcing issues. I know re-reading your own writing can be tiring and it's all too easy to run out of steam. But please go through to make sure every fact has a reliable reference (e.g. I'm looking at the Signs & symptoms section now and the first sentence The clinical signs of a hemothorax include reduced or absent breath sounds and reduced movement of the chest wall on the affected side is not supported by the reference). Also high-quality sources are preferable to medium-quality sources. So if we can replace the remaining case reports, and maybe even the StatPearls articles (found the previous discussions here and here that left me with the impression that the StatPearls articles are of medium quality) we should. Lastly I'll be a bit more hands-on editing as I read, so please check my work to make sure I don't write anything idiotic. Sorry for the slow movement here and all the text we've generated. Hopefully we're moving towards a really nice resource! Ajpolino (talk) 20:26, 24 January 2021 (UTC)

  Ajpolino, I have fixed all the problematic sourcing in the Symptoms section. Steve M (talk) 21:54, 24 January 2021 (UTC)

  To be clear, I'd suggest you apply the same scrutiny to the whole article. There are references to several case reports (currently refs #12, 15, 32) and three StatPearls articles. Again, these aren't necessarily bad, but if a superior source exists it should be used. If no superior source exists, you should have some reason for why the article is incomplete without the information in question (you don't need to express that reason here, but be prepared to mention it at FAC if someone asks). One more: I don't know what this source is, but someone will likely ask you at FAC so be prepared to explain why it's reliable. Ajpolino (talk) 22:03, 24 January 2021 (UTC)

  Ajpolino, I'm 100% sure that source is useless and can be removed. Not only is it unreliable, but it has nothing to offer. Steve M (talk) 23:08, 24 January 2021 (UTC)

  The source has been removed Steve M (talk) 00:20, 25 January 2021 (UTC)

  I don't really think there are any good sources that describe symptoms in detail. I looked through all review articles and three of the top books. It has been very difficult to find sources. Steve M (talk) 03:04, 28 January 2021 (UTC)

  Ajpolino, in general, this topic suffers due to its severe lack of available secondary sources. Therefore, it was hard to find and good sources that say much about epidemology. Steve M (talk) 03:08, 28 January 2021 (UTC)

• Regarding the "Comprehensiveness" criterion (expanded on a bit here):

  Is there anything else that can be said about Signs & symptoms? I had trouble finding much info on the topic, but it's hard to believe there's not more information available?

  Similar question for the Traumatic subsection of Causes - we want to cover each topic according to its important (and consequently according to how much it's covered in reliable sources). It seems most hemothorax is from trauma, so is there anything else useful we can add to this article on the topic?

  Same for epidemiology - anything else we can add to make the article comprehensive?

  Conversely, now there's a lot of material on horses, even though the article claims it's uncommon. Ratios don't need to be exact, but it seems odd to give the readers five times as much on horse hemothorax as on how trauma causes hemothorax. Perhaps hemothorax in horses is more common than I'm getting from reading the section?