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Hemothorax

Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

Causes

The most common cause of hemothorax is chest trauma. Hemothorax can also occur in people who have:

  • Blood clotting defect
  • Chest (thoracic) or heart surgery
  • Death of lung tissue (pulmonary infarction)
  • Lung or pleural cancer -- primary or secondary (metastatic, or from another site)
  • Tear in a blood vessel when placing a central venous catheter or when associated with severe high blood pressure
  • Tuberculosis

Symptoms

Symptoms include:

Exams and Tests

Your health care provider may note decreased or absent breath sounds on the affected side. Signs or findings of hemothorax may be seen on the following tests:

Treatment

The goal of treatment is to get the person stable, stop the bleeding, and remove the blood and air in the pleural space.

  • A chest tube is inserted through the chest wall between the ribs to drain the blood and air.
  • It is left in place and attached to suction for several days to re-expand the lung.

If a chest tube alone does not control the bleeding, surgery (thoracotomy) may be needed to stop the bleeding.

The cause of the hemothorax will be also treated. The underlying lung may have collapsed. This can lead to breathing difficulty. In people who have had an injury, chest tube drainage may be all that is needed. Surgery may not be necessary.

WHAT TO EXPECT AT THE EMERGENCY DEPARTMENT

The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as needed. The person may receive:

  • Breathing support -- This may include oxygen, endotracheal intubation (tube through the nose or mouth into the trachea) and ventilator (breathing machine)
  • Blood tests and possible blood transfusion
  • Chest tube (tube through the skin and muscles between the ribs into the space around the lungs) if there is lung collapse
  • CAT/CT scan
  • Pleural fluid analysis (fluid is often very bloody or blood-tinged)
  • EKG
  • Fluids given through the vein (IV)
  • Medicines to treat symptoms
  • X-rays of chest and abdomen or other parts of the body if there are additional injuries

Outlook (Prognosis)

The outcome depends on the cause of the hemothorax, the amount of blood loss and how quickly treatment is given.

In the case of major trauma, the outcome will depend on the severity of the injury and the rate of bleeding.

Possible Complications

Complications may include:

  • Collapsed lung, or pneumothorax, leading to respiratory failure (inability to breathe properly, provide the body enough oxygen and remove carbon dioxide)
  • Fibrosis or scarring of the pleural membranes and underlying lung tissue
  • Infection of the pleural fluid (empyema)
  • Shock and death in severe circumstances

When to Contact a Medical Professional

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:

  • Dizziness, lightheadedness, fever and cough, or a feeling of heaviness in your chest
  • Severe chest, neck, jaw, shoulder or arm pain
  • Severe difficulty breathing

Prevention

Use safety measures (such as seat belts) to avoid injury. Depending on the cause, a hemothorax may not be preventable.

References

Moore SM, Pieracci FM, Jurkovich GJ. Chest wall, pneumothorax, and hemothorax. In: Cameron JL, Cameron AM, eds. Current Surgical Therapy. 12th ed. Philadelphia, PA: Elsevier; 2017:1151-1158.

Raja AS. Thoracic trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 38.

Light RW, Lee YCG. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray & Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 81.

    • Aortic rupture, chest X-ray

      Aortic rupture, chest X-ray - illustration

      Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest X-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the X-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.

      Aortic rupture, chest X-ray

      illustration

    • Respiratory system

      Respiratory system - illustration

      Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

      Respiratory system

      illustration

    • Chest tube insertion - series - Pleural cavity

      Chest tube insertion - series - Pleural cavity

      Presentation

      • Aortic rupture, chest X-ray

        Aortic rupture, chest X-ray - illustration

        Aortic rupture (a tear in the aorta, which is the major artery coming from the heart) can be seen on a chest X-ray. In this case, it was caused by a traumatic perforation of the thoracic aorta. This is how the X-ray appears when the chest is full of blood (right-sided hemothorax) seen here as cloudiness on the left side of the picture.

        Aortic rupture, chest X-ray

        illustration

      • Respiratory system

        Respiratory system - illustration

        Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

        Respiratory system

        illustration

      • Chest tube insertion - series - Pleural cavity

        Presentation

      Review Date: 6/24/2018

      Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Emeritus, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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