Hemothorax

Hemothorax occurs when blood enters the pleural cavity from damaged intercostal, pleural, or mediastinal vessels (or occasionally from the lung's parenchymal vessels). Depending on the amount of blood and the underlying cause of bleeding, hemothorax can cause varying degrees of lung collapse. About 25% of patients with chest trauma (blunt or penetrating) experience hemothorax. Pneumothorax (air in the pleural cavity) commonly accompanies hemothorax.

Causes

Hemothorax usually results from either blunt or penetrating chest trauma. Less often, it occurs as a consequence of thoracic surgery, pulmonary infarction, neoplasm, dissecting thoracic aneurysm, or anticoagulant therapy.

Signs and Symptoms

• Chest pain
• Shortness of breath
• Respiratory failure
• Rapid heart rate
• Anxiety
• Restlessness

Diagnostic tests

Thoracentesis performed for diagnosis and therapy may yield blood or serosanguineous fluid. Fluid specimens may be sent to the laboratory for analysis.

Chest X-rays display pleural fluid and reveal mediastinal shift, and arterial blood gas (ABG) analysis is used to document respiratory failure.

Hemoglobin levels may be decreased, depending on blood loss.

Treatment

In hemothorax, the goal of treatment is to stabilize the patient's condition, stop the bleeding, evacuate blood from the pleural cavity, and reexpand the affected lung. Mild hemothorax usually clears in 10 to 14 days, requiring only observation for further bleeding. In severe hemothorax, treatment includes thoracentesis to remove blood and other fluids from the pleural cavity and then insertion of a chest tube into the sixth intercostal space in the posterior axillary line. The diameter of a typical chest tube is large to prevent clots from blocking it. Suction may also be used. If the chest tube doesn't improve the patient's condition, the surgeon may need to perform a thoracotomy to evacuate blood and clots and control bleeding.

Autotransfusion may be used if the patient's blood loss approaches or exceeds 1 L.

Other treatment measures include oxygen therapy, I. V. therapy to restore fluid volume, and analgesics.

Prevention

Use safety measures (such as seat belts) to avoid injury. Depending on the cause, a hemothorax may not be preventable.