Hemothorax
Updates to Article Attributes
Haemothorax literally means blood within the chest, is a term usually used to described a pleural effusion due to accumulation of blood. If a haemothorax occurs concurrently with a pneumothorax it is then termed a haemopneumothorax.
A tension heemothorax refers to haemothorax thats result from massive intrathoracic bleeding causing ipsilateral lung compression and mediastinal displacement 9.
Pathology
A haemothorax is sometimes defined by is extraction of pleural fluid with a haematocrit > 50% of the blood haematocrit.
Causes
It usually occurs from penetrating or blunt trauma 3 to the chest (traumatic haemothorax).
A haemothorax can also result without any antecedant trauma and in these situations it is termed a spontaneous haemothorax. This can occur in the setting of 8
- intrathoracic malignancy
- usually occurs with thoracic wall tumours
- soft-tissue tumours
- sarcomas: thoracic angiosarcomas
- hepatocellular carcinomas: with thoracic invasion or thoracic metastases
- lung cancer is a distinctly uncommon cause of haemothorax even in the setting of pleural extension 8
- spontaneous pneumothorax - spontaneous haemopneumothorax
- anticoagulant medication
- vascular rupture
- aortic dissection
rupture of coronary arteries such as RCA during an angioplasty
-
thoracic arteriovenous malformations
- thoracic endometriosis
- pulmonary infarction
- pleural adhesions with pneumothorax
- haematologic abnormalities: coagulopathy
- connective tissue disease
- Ehlers-Danlos syndrome (EDS) type IV: has been associated with haemothorax in the setting of internal mammary artery rupture
- congenital bony exostoses
Radiographic features
RadiographPlain radiograph
AChest radiographic appearance of a large haemothorax may be seen as a similar to that of pleural effusion. It can be almost impossible to differentiate a haemothorax from other causes of pleural effusions.
Ultrasound
May have very high sensitivity (92% 2), specificity (100% 2) positive predictive values (100%2) and negative predictive values (98%2) in detection of a haemothorax the context of preceding trauma.
CT
CT is useful in determining the nature of pleural fluid in the setting of trauma by assessing the attenuation value. Blood in the pleural space typically has an attenuation of 35-70 HU 6. Pleural fluid attenuation measurement should be routine in the interpretation of chest trauma CT to distinguish simple fluid from acute blood.
In the setting of trauma, there may be other ancillary features such as pulmonary contusions and lacerations.
Complications
Recognised complications that can after a retained haemothorax include 7
- infection
- chronic fibrothorax
Treatment and prognosis
Management
The exact management strategy with depend on underlying aetiology. In general management options include:
- drainage for symptomatic therapy
For a clotted haemothorax options include:
- video assisted thoracoscopic surgery (VATS)
- intrapleural fibrinolytic therapy (IPFT)
-</ul><h4>Radiographic features</h4><h5>Radiograph</h5><p>A large haemothorax may be seen as a pleural effusion. It can be almost impossible to differentiate a haemothorax from other causes of pleural effusions.</p><h5>Ultrasound</h5><p>May have very high sensitivity (92%<sup> 2</sup>), specificity (100% <sup>2</sup>) positive predictive values (100%<sup>2</sup>) and negative predictive values (98%<sup>2</sup>) in detection of a haemothorax the context of preceding trauma.</p><h5>CT</h5><p>CT is useful in determining the nature of pleural fluid in the setting of trauma by assessing the attenuation value. Blood in the pleural space typically has an attenuation of 35-70 HU <sup>6</sup>. Pleural fluid attenuation measurement should be routine in the interpretation of chest trauma CT to distinguish simple fluid from acute blood.</p><p>In the setting of trauma, there may be other ancillary features such as <a href="/articles/pulmonary-contusion">pulmonary contusions</a> and <a href="/articles/pulmonary-laceration-1">lacerations</a>.</p><h4>Complications</h4><p>Recognised complications that can after a retained haemothorax include <sup>7</sup></p><ul>- +</ul><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Chest radiographic appearance of a large haemothorax may be similar to that of <a title="Pleural effusion" href="/articles/pleural-effusion">pleural effusion</a>. It can be almost impossible to differentiate a haemothorax from other causes of pleural effusions.</p><h5>Ultrasound</h5><p>May have very high sensitivity (92%<sup> 2</sup>), specificity (100% <sup>2</sup>) positive predictive values (100%<sup>2</sup>) and negative predictive values (98%<sup>2</sup>) in detection of a haemothorax the context of preceding trauma.</p><h5>CT</h5><p>CT is useful in determining the nature of pleural fluid in the setting of trauma by assessing the attenuation value. Blood in the pleural space typically has an attenuation of 35-70 HU <sup>6</sup>. Pleural fluid attenuation measurement should be routine in the interpretation of chest trauma CT to distinguish simple fluid from acute blood.</p><p>In the setting of trauma, there may be other ancillary features such as <a href="/articles/pulmonary-contusion">pulmonary contusions</a> and <a href="/articles/pulmonary-laceration-1">lacerations</a>.</p><h4>Complications</h4><p>Recognised complications that can after a retained haemothorax include <sup>7</sup></p><ul>
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