Hemothorax is an accumulation of blood between the lung and the chest wall.
People may feel light-headed and short of breath and have chest pain, and the skin may be cool, sweaty, or bluish.
Doctors do a chest x-ray to make the diagnosis.
People are given fluids intravenously or a blood transfusion, and a tube is inserted in the chest to drain the blood.
(See also Introduction to Chest Injuries.)
Hemothorax can result from any injury—blunt or penetrating―that cuts or tears a lung or an artery or vein in the chest. Blood may then accumulate in the pleural space―between the 2 layers of tissue that cover the lungs. A large amount of blood may press on the lungs and make breathing difficult. When air as well as blood enters this space, the disorder is called hemopneumothorax. Occasionally, hemothorax is caused by chest surgery or another disorder, such as tuberculosis or lung cancer.
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Symptoms of Hemothorax
Hemothorax is not painful, but the injury that caused it usually is. The severity of other symptoms depends in part on the amount of blood in the chest cavity. If the amount of blood is small, people usually have no other symptoms. People with a large amount of blood may feel short of breath, and breathing may be shallow and rapid. A massive amount of blood may cause blood pressure to become dangerously low (shock). The skin may be cool, sweaty, and bluish.
Diagnosis of Hemothorax
Chest x-ray
Sometimes ultrasonography
If doctors suspect hemothorax, they take a chest x-ray or, particularly if rapid diagnosis is necessary, do a bedside ultrasound procedure called E-FAST (Extended Focused Assessment With Sonography in Trauma) to detect blood in the pleural space between the lung and the chest wall.
Treatment of Hemothorax
Intravenous fluid and sometimes blood products to maintain blood pressure
Chest tube insertion
Doctors give fluids intravenously to increase the amount of fluid in the bloodstream and thus increase blood pressure. If a large amount of blood has been lost, a blood transfusion is necessary.
Doctors usually insert a chest tube (thoracostomy) into the chest to remove the blood and to allow the lung to reinflate. The tube may need to remain in place for several days.
If a lot of blood is present or if bleeding continues, surgery (thoracotomy) may be done to stop the bleeding.
