Hemothorax

Answer 1

Definition

Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

Causes, incidence, and risk factors

The most common cause of hemothorax is chest trauma. It can also occur in patients who have:

• A defect of blood clotting
• Blunt trauma to the chest
• Death of lung tissue (pulmonary infarction)
• Lung or pleural cancer
• Penetrating chest trauma (when a weapon such as a knife or bullet cuts the lung)
• Placement of a central venous catheter
• Thoracic or heart surgery
• Tuberculosis

Symptoms

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

Signs and tests

Your doctor may note decreased or absent breath sounds on the affected side. Signs of hemothorax may be seen on the following tests:

• Chest x-ray
• CT scan
• Pleural fluid analysis
• Thoracentesis

Treatment

The goal of treatment is to stabilize the patient, stop the bleeding, and remove the blood and air in the pleural space. A chest tube is inserted through the chest wall to drain the blood and air. It is left in place for several days to re-expand the lung.

When a hemothorax is severe and a chest tube alone does not control the bleeding, surgery (thoracotomy) may be needed to stop the bleeding.

The cause of the hemothorax should be also treated. In trauma patients, depending on the severity of the injury, chest tube drainage is often all that is necessary. Surgery is often not required.

Expectations (prognosis)

The outcome depends on the cause of the hemothorax and how quickly treatment is given.

Complications

• Collapsed lung, leading to respiratory failure
• Death
• Fibrosis or scarring of the pleural membranes
• Pneumothorax
• Shock

Calling your health care provider

Call 911 if you have:

• Any serious injury to the chest
• Chest pain or shortness of breath

Go to the emergency room or call the local emergency number (such as 911) if you have:

• Severe chest pain
• Severe difficulty breathing
• Symptoms of hemothorax

Prevention

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

References

Eckstein M, Henderson S. Thoracic trauma. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 42.

Answer 2

Definition

Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

Causes, incidence, and risk factors

The most common cause of hemothorax is chest trauma. It can also occur in patients who have:

• A defect of blood clotting
• Death of lung tissue (pulmonary infarction)
• Lung or pleural cancer
• Placement of a central venous catheter
• Thoracic or heart surgery
• Tuberculosis

Symptoms

• Anxiety
• Chest pain
• Low blood pressure
• Pale, cool and clammy skin
• Rapid heart rate
• Rapid, shallow breathing
• Restlessness
• Shortness of breath

Signs and tests

Your doctor may note decreased or absent breath sounds on the affected side. Signs of hemothorax may be seen on the following tests:

• Chest x-ray
• CT scan
• Pleural fluid analysis
• Thoracentesis

Treatment

The goal of treatment is to get the patient stable, stop the bleeding, and remove the blood and air in the pleural space. A chest tube is inserted through the chest wall to drain the blood and air. It is left in place for several days to re-expand the lung.

When a hemothorax is severe and a chest tube alone does not control the bleeding, surgery (thoracotomy) may be needed to stop the bleeding.

The cause of the hemothorax should be also treated. In people who have had an injury, chest tube drainage is often all that is needed. Surgery is often not needed.

Expectations (prognosis)

The outcome depends on the cause of the hemothorax and how quickly treatment is given.

Complications

• Collapsed lung, leading to respiratory failure
• Death
• Empyema
• Fibrosis or scarring of the pleural membranes
• Pneumothorax
• Shock

Calling your health care provider

Call 911 if you have:

• Any serious injury to the chest
• Chest pain or shortness of breath

Go to the emergency room or call the local emergency number (such as 911) if you have:

• Dizziness, fever, or a feeling of heaviness in your chest
• Severe chest pain
• Severe difficulty breathing

Prevention

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

References

Light RW, Lee YCG. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier;2010:chap 74.

Reviewed By

Review Date: 11/01/2010

Shabir Bhimji MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.