Hemothorax: What you need to know
It refers to a collection of blood between the chest wall and the lung.
A number of causes and symptoms can help doctors identify and treat the condition quickly.
The most common cause is a traumatic injury to the chest, such as a puncture wound from a broken rib or blunt force injury resulting from a car accident.
People may experience different symptoms depending on the progression of the hemothorax. Diagnosing hemothorax may involve both a physical examination and an imaging test.
Treatment of this serious condition involves stabilizing the patient if they have been injured, removing all of the blood in the chest, and stopping the source of the bleeding.
- Hemothorax either stems from an extrapleural injury or an intrapleural injury.
- An extrapleural injury is caused by damage to the chest wall tissues on the outside of the pleural space. An intrapleural injury is due to damage to the inside of the pleural cavity.
- Hemothorax often occurs with pneumothorax, which is excess air in the pleural cavity.
- Symptoms include chest pain and a rapid heart rate.
- Treatment involves placing a catheter through the ribs to drain the blood and remove air.
In the case of hemothorax, blood collects in a space called the pleural cavity, which is between the chest wall and the lung. There are several possible causes including the following:
A traumatic injury to the chest may be the most common cause of hemothorax.
Traumatic hemothorax often causes the pleural membrane lining the chest or lungs to rupture. This ruptured membrane spills blood into the pleural space, which has no way of being drained.
Even the smallest injuries to the chest wall or lungs can lead to hemothorax.
It has become standard procedure for emergency medical staff to inspect a person's lungs for signs of hemothorax after an accident or another impact injury, such as a sports injury.
Other issues may cause hemothorax. Certain people may be more at risk for hemothorax depending on underlying conditions.
This is called spontaneous hemothorax and it can affect people with:
- lung infections, such as tuberculosis
- certain cancers or maligancies, 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
- tears in a blood vessel in the lungs may cause severely high blood pressure
Hemothorax can also be caused by a medical procedure, such as placing a venous catheter or having heart surgery. In more rare cases, hemothorax can also occur spontaneously.
Another problem that can result from a trauma to the chest is pneumothorax. In this case, air collects in the chest cavity. If a person has both, this is called hemopneumothorax.
Hemothorax presents some unique symptoms, which can help both patients and doctors identify 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 restlessness
A massive hemothorax is when the accumulation of blood is large, being at least 1,000 milliliters, or one liter. This can lead to shock.
People with signs of pneumothorax or other related disorders may experience additional symptoms as well.
A hemothorax may be diagnosed with an X-ray or a CT scan.
During a physical exam, doctors will listen for sounds of abnormal breathing through a stethoscope. Doctors may also tap on the chest to listen for sounds of liquid.
Other methods of diagnosis include:
- X-rays: an X-ray image of the chest will quickly reveal if there is liquid in the chest cavity. In an X-ray, the lungs will show up black, where the pleural fluid and any blood in the chest cavity will show up white.
- CT scans: this can give doctors a complete image of the lungs and pleural cavity, which may be especially important in cases of injury. A full CT scan of the chest can often reveal the cause of the hemothorax and the best treatment for the individual.
- Ultrasound: in emergency situations, ultrasound images provide a quick and accurate look into the pleural space for potential damage and hemothorax.
Doctors may also want to take a sample of the pleural fluid for their diagnosis. The liquid they remove is likely to be bloody or be stained by blood if the person has hemothorax.
There are a few things that need to be done to ensure successful treatment.
Firstly, a doctor inserts a needle or catheter into the chest through the ribs. It is used to remove the blood and air that has gotten into the pleural cavity.
Except in the case of an emergency, a doctor will use a numbing agent and sedation before inserting the catheter.
After draining the chest, the doctor may use the same tube to help expand the affected lung if it has collapsed.
The chest tube is left attached to a closed system that allows the fluid and air to escape but no more air to enter the pleural space. This system may be hooked up to suction or left in a setting called water seal.
To correctly treat the hemothorax, the cause must be addressed. In people with a small injury, chest drainage may be all that is required. Other people may need surgery to stop the bleeding at its source.
People who undergo major surgery may be at an increased risk of hemothorax.
Hemothorax is usually the result of an accident or another traumatic injury that can be difficult to prevent in many cases. There are additional risk factors including:
- Surgery: people who are having major surgeries such as open heart surgery or a lung transplant may be more likely to experience hemothorax. Doctors will monitor them during and after surgery for any signs of blood or liquid in the lungs.
- Repetitive injury: hemothorax may be caused by blunt force when taking part in athletic activities, such as football, martial arts, and boxing. There may be a higher risk for those participating in sports or other activities that may cause repetitive blunt impact to the chest, abdomen, or shoulders.
Complications caused by the hemothorax are also possible. They include:
- Lung problems: the pressure of the blood in the chest can cause a collapsed lung. If it progresses, this may lead to respiratory failure.
- Infection: a hemothorax that goes untreated may also cause an infection in the lung, pleura, or pleural fluid in the chest cavity.
- Scarring: the pleural membranes and lung tissue are also more prone to scarring with hemothorax. Over time, this can lead to fibrosis and immobilized ribs.
Complications may require additional surgery or medical attention. In severe cases, hemothorax can cause the body to go into shock, which may be fatal.
Retained hemothorax is a complication that occurs when the blood stays in the plural cavity too long. The blood may clot and be difficult to remove through a catheter. Blood that remains in the chest too long can cause pus to build up in the surrounding area as well, which can lead to an infection.
Retained hemothorax is treated by inserting a different chest tube into the pleural space to help with drainage or by a video-assisted surgical procedure.
Hemothorax is a serious condition that can be life-threatening if left untreated. Where a person has received medical attention, diagnosis and treatment outcomes are good.
Without medical care, this is not always the case. Anyone who has had chest injury should get checked out for hemothorax. Symptoms of hemothorax require immediate medical attention. A medical team can reduce the risk of serious complications in the case of emergency treatment.
Recovery depends on how well the person responds to treatment and how long it takes the blood to clear out of the pleural space.