Hemothorax

Hemothorax

An X-ray showing the presence of a hemothorax.

Hemothorax is a medical condition characterized by the accumulation of blood in the pleural cavity—the space between the lungs and the chest wall. This condition is a type of Pleural effusion and is considered a medical emergency. Hemothorax can compromise breathing and, if left untreated, can lead to serious health complications, including respiratory failure and shock.

Definition and Pathophysiology

Hemothorax occurs when blood collects in the pleural space, which normally contains a small amount of fluid to facilitate lung movement during breathing. The presence of blood in this space can be due to trauma, medical procedures, or pathological processes that disrupt the blood vessels within the chest cavity.

Causes

The most common causes of hemothorax include:

Chest trauma

Such as from a motor vehicle accident, fall, or penetrating injury, which can damage the blood vessels of the lung or chest wall.

Surgery

Complications from chest or heart surgery may lead to a hemothorax.

Pulmonary embolism

A pulmonary embolism with infarction can lead to bleeding into the pleural space.

Malignancy

Tumors in the chest can erode into blood vessels, causing a hemothorax.

Coagulopathy

Disorders of blood clotting can predispose an individual to bleeding, including into the pleural cavity.

Symptoms

Symptoms of a hemothorax can vary depending on the volume of blood accumulated and may include:

• Chest pain
• Shortness of breath
• Low blood pressure
• Rapid heartbeat
• Bluish skin due to lack of oxygen

Diagnosis

Diagnosis of hemothorax generally includes:

• Physical examination, which may reveal reduced breath sounds on the affected side
• Chest X-rays showing a fluid level in the pleural space
• Ultrasound of the chest, which can detect fluid accumulation
• CT scan of the chest for a more detailed assessment
• Thoracentesis, where a needle is inserted into the pleural space to obtain a sample of the fluid for analysis

Treatment

Treatment of hemothorax typically involves:

• Immediate stabilization of the patient's airway, breathing, and circulation
• Chest tube insertion to drain the blood from the pleural space
• Surgery in cases of ongoing bleeding or large, clotted hemothorax
• Treatment of the underlying cause of the hemothorax
• Blood transfusions if a significant amount of blood is lost

Prognosis and Complications

The prognosis for individuals with hemothorax depends on the cause and the promptness of treatment. Potential complications include:

• Infection leading to Empyema
• Fibrothorax due to scarring and entrapped lung
• Pneumonia

Preventive Measures

Preventive measures for hemothorax focus on minimizing chest trauma and managing underlying health conditions that could contribute to bleeding.

See Also

• Pleural cavity
• Thoracic surgery
• Trauma surgery

References

• Clinical Aspects of Hemothorax. Thoracic Medicine, 2023.
• Emergency Management of Hemothorax. Trauma Care, 2023.

External Links

• American Thoracic Society: Hemothorax Patient Information
• eMedicine: Hemothorax Overview

Hemothorax Resources
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