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Hemothorax

By

Thomas G. Weiser

, MD, MPH, Stanford University School of Medicine

Last full review/revision May 2020| Content last modified May 2020
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Hemothorax is accumulation of blood in the pleural space.

The usual cause of hemothorax is laceration of the lung, intercostal vessel, or an internal mammary artery. It can result from penetrating or blunt trauma. Hemothorax is often accompanied by pneumothorax Pneumothorax Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical... read more Pneumothorax (hemopneumothorax).

Hemorrhage volume ranges from minimal to massive. Massive hemothorax is most often defined as rapid accumulation of ≥ 1000 mL of blood. Shock Shock Shock is a state of organ hypoperfusion with resultant cellular dysfunction and death. Mechanisms may involve decreased circulating volume, decreased cardiac output, and vasodilation, sometimes... read more is common.

Patients with large hemorrhage volume are often dyspneic and have decreased breath sounds and dullness to percussion (often difficult to appreciate during initial evaluation of patients with multiple injuries). Findings may be unremarkable in patients with smaller hemothoraces.

Diagnosis of Hemothorax

  • Chest x-ray

Hemothorax is suspected based on symptoms and physical findings. Diagnosis is typically confirmed by chest x-ray.

Treatment of Hemothorax

  • Fluid resuscitation as needed

  • Usually tube thoracostomy

  • Sometimes thoracotomy

If blood volume is sufficient to be visible on chest x-ray (usually requiring about 500 mL), or if pneumothorax Pneumothorax Pneumothorax is air in the pleural space causing partial or complete lung collapse. Pneumothorax can occur spontaneously or result from trauma or medical procedures. Diagnosis is based on clinical... read more Pneumothorax is present, a large-caliber (eg, 32 to 38 Fr) chest tube is inserted in the 5th or 6th intercostal space in the midaxillary line. Tube drainage improves ventilation, decreases risk of clotted hemothorax (which can lead to empyema or fibrothorax), and facilitates assessment of ongoing blood loss and diaphragmatic integrity. Blood collected via tube thoracostomy can be autotransfused, decreasing the requirement for crystalloid and exogenous blood.

Urgent thoracotomy is indicated in either of the following situations:

  • Initial bleeding is > 1500 mL

  • Bleeding is > 200 mL/hour for > 2 to 4 hours and causes respiratory or hemodynamic compromise or the need for repeated blood transfusions.

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