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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).

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

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 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

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:

Prevention

Use safety measures (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.


Review Date: 10/10/2008
Reviewed By: Robert A. Cowles, MD, Assistant Professor of Surgery, Columbia University College of Physicians and Surgeons, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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