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Hemothorax

Definition

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

Figures

Causes, incidence, and risk factors

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

Blood clotting defect
Chest (thoracic) or heart surgery
Death of lung tissue (pulmonary infarction)
Lung or pleural cancer
Tear in a blood vessel when placing a central venous catheter
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:

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
Fibrosis or scarring of the pleural membranes
Infection of the pleural fluid (empyema)
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.

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