Hemothorax is the accumulation of blood in the pleural space (the space between the lung and the chest wall), which can result from trauma, surgery, or other pathological conditions. Treatment depends on the severity and underlying cause. A range of causes and symptoms can help doctors quickly recognize and treat the condition. The most common cause is a traumatic injury to the chest, such as a puncture wound from a broken rib or blunt force trauma resulting from a car accident. People may experience different symptoms depending on the progression of the hemothorax. Diagnosis of hemothorax may include both a physical examination and imaging tests. Treatment of this serious condition includes stabilizing the patient if they have been injured, removing all blood in the chest, and stopping the source of the bleeding.

Reasons

In the case of hemothorax, blood collects in a space called the pleural cavity, which is located between the chest wall and the lung. There are several possible causes, including: Wounding: Traumatic hemothorax often causes a rupture of the pleural membrane that covers the chest or lungs. This rupture of the membrane spills blood into the pleural space, which has no way to drain. Even minor injuries to the chest wall or lungs can lead to hemothorax. It has become protocol for emergency medical personnel to inspect a person's lungs for signs of hemothorax after an accident or other impact injury, such as a sports injury.

Other causes

Some people may be at higher risk for hemothorax depending on underlying conditions:

• lung infections, such as tuberculosis
• certain cancers or malignancies, such as lung or pleural cancer
• pulmonary embolism, which is a blood clot in the lungs
• defects in blood clotting, for example, due to the use of anticoagulant drugs or hemophilia
• lung tissue dysfunction, such as pulmonary infarction

Hemothorax can also be caused by a medical procedure, such as the placement of a venous catheter or heart surgery. Another problem that can arise from a chest injury is a pneumothorax. In this case, air collects in the chest cavity. If a person has both, it is called a hemopneumothorax.

Symptoms

Hemothorax presents with some unique symptoms, which can help both patients and doctors recognize it if the signs are not obvious. Symptoms of hemothorax include:

• chest pain, especially when breathing
• cold, pale, or clammy skin
• rapid heart rate
• low blood pressure
• tense, rapid, or shallow breathing
• difficulty breathing
• feelings of anxiety

Diagnosis

During a physical exam, doctors will listen for abnormal breath sounds through a stethoscope. Doctors may also tap (percussion) on the chest to hear the sounds of fluid. Other diagnostic methods include:

X-rays: A chest X-ray will quickly reveal if there is fluid in the chest cavity.

Computed tomography: can give doctors a complete picture of the lungs and pleural cavity, which can be especially important in cases of injury. A full chest CT scan can often reveal the cause of the hemothorax and the best treatment for the person.

Ultrasound: In emergency situations, ultrasound images provide a quick and accurate look at the pleural space for potential damage and hemothorax.

Treatment

1. Stabilization of the patient:
   • Ensuring vital signs (heart rate, breathing, blood pressure).
   • Administer oxygen if necessary.
   • Treat hypovolemia with fluids and/or blood transfusions.
2. Removal of blood from the pleural space:
   • Chest tube insertion (thoracostomy): A tube is placed in the pleural space to drain blood.
   • Thoracentesis: In smaller hemothoraxes, simple aspiration can be performed.
3. Treating bleeding:
   • If the hemothorax is large or bleeding continues (>1500 ml initially or >200 ml/hour), surgical intervention may be required.
   • Thoracoscopic surgery (VATS): Minimally invasive approach for diagnosis and treatment.
   • Thoracotomy: Open surgery to locate and stop bleeding.
4. Addressing underlying causes:
   • In traumatic hemothorax, the trauma is treated (e.g., rib fractures, ruptured organs).
   • In non-traumatic hemothorax, conditions such as cancer or ruptured aneurysm are investigated.
5. Monitoring:
   • Regular check-ups with chest X-ray or CT scan to evaluate recovery.
   • Monitoring for complications such as empyema (infection of the pleural fluid) or pneumothorax.

Epilogue

Hemothorax is a serious condition that can be life-threatening if left untreated. When a person receives medical attention, the outcomes of diagnosis and treatment are good. Recovery depends on how well the person responds to treatment and how long it takes for the blood to clear from the pleural space.