Hemothorax

The term hemothorax refers to the presence of blood in the pleural cavity.

Blood Sources
Bleeding may have a single etiology or may involve multiple factors.
 * 1) rib fractures (approximately 100 ml from one rib),
 * 2) intercostal artery trauma,
 * 3) trauma of a. thoracica interna,
 * 4) trauma of a. subclavia,
 * 5) trauma of thoracic aorta, aneurysm rupture of thoracic aorta,  hilar vascular trauma (rare).

Division of Hemothorax

 * 1) small (up to 500 ml),
 * 2) medium (500–1500 ml),
 * 3) large (massive – over 1500 ml).


 * Pneumothorax hemothorax pneumomediastinum contusion.JPGve hemothorax is an immediately life-threatening condition - there's a risk of hypovolemia and shock, pulmonary oppression and malfunction of ventilation, often combined with pneumothorax.

Clinical Symptoms

 * 1) shortness of breath,
 * 2) cyanosis,
 * 3) hypotension (a sign of shock in massive hemothorax),
 * 4) weakened breathing and darkened percussion on the affected side, the jugular veins may have a higher filling (blockage of venous return) or, conversely, may be collapsed (in shock),
 * 5) X-RAY shading of the pleural cavity with a wiped contour of the diaphragm and the upper edge higher laterally (smaller hemothorax may not be demonstrable in the supine position, imaging is better during standing - for massive hemothorax, blurring above half of the scapula indicates, fluid volume determination is more accurate at ultrasound).

Treatment

 * Punction, better drainage in the axillary midline in the 6th intercostal space at the upper edge of the lower rib:
 * waste up to 1000 ml – bleeding usually stops spontaneously,
 * waste over 1500 ml once or ongoing losses over 300ml/h – urgent thoracotomy with the treatment of the source of bleeding is indicated.


 * In case of hypovolemia in massive hemothorax, it is necessary to infuse as soon as possible whole blood.
 * Incomplete evacuation of the hemothorax results in pleural adhesions with limited respiratory movements, and hematoma infection causes empyema.

Related Articles

 * Pleural Effusion
 * Chylothorax
 * Empyema
 * Fibrothorax
 * Pneumothorax