Hemothorax
Updates to Article Attributes
A haemothoraxHaemothorax which literally 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 hematocrit > 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
-
intra thoracicintrathoracic malignancy-- usually occurs with thoracic wall tumours
- soft-tissue tumours
- sarcomas
-: thoracic angiosarcomas
- sarcomas
-
hepatocellular carcinomas
- with: 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
- thoracic arteriovenous malformations
- thoracic endometriosis
- pulmonary infarction
- adhesions with pneumothorax
- haematologic abnormalities
-: coagulopathy - connective tissue disease
-
Ehlers-Danlos syndrome (EDS) type IV
- has
-
Ehlers-Danlos syndrome (EDS) type IV
- congenital bony exostoses
Radiographic features
Plain film
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.
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 chest
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)
-<p>A <strong>haemothorax</strong> which literally means blood within the chest, is a term usually used to described a <a href="/articles/pleural-effusion">pleural effusion</a> due to accumulation of blood. If a haemothorax occurs concurrently with a <a href="/articles/pneumothorax">pneumothorax</a> it is then termed a <a href="/articles/haemopneumothorax">haemopneumothorax</a>. </p><p>A <a href="/articles/tension-heemothorax">tension heemothorax</a> refers to haemothorax thats result from massive intrathoracic bleeding causing ipsilateral lung compression and mediastinal displacement <sup>9</sup>.</p><h4>Pathology</h4><p>A haemothorax is sometimes defined by is extraction of pleural fluid with a hematocrit > 50% of the blood haematocrit.</p><h5>Causes</h5><p>It usually occurs from penetrating or blunt trauma <sup>3 </sup>to the chest (<a href="/articles/traumatic-haemothorax">traumatic haemothorax</a>). </p><p>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 <sup>8</sup></p><ul>-<li>intra thoracic malignancy - <ul>- +<p><strong>Haemothorax</strong> literally means blood within the chest, is a term usually used to described a <a href="/articles/pleural-effusion">pleural effusion</a> due to accumulation of blood. If a haemothorax occurs concurrently with a <a href="/articles/pneumothorax">pneumothorax</a> it is then termed a <a href="/articles/haemopneumothorax">haemopneumothorax</a>. </p><p>A <a href="/articles/tension-heemothorax">tension heemothorax</a> refers to haemothorax thats result from massive intrathoracic bleeding causing ipsilateral lung compression and mediastinal displacement <sup>9</sup>.</p><h4>Pathology</h4><p>A haemothorax is sometimes defined by is extraction of pleural fluid with a hematocrit > 50% of the blood haematocrit.</p><h5>Causes</h5><p>It usually occurs from penetrating or blunt trauma <sup>3 </sup>to the chest (<a href="/articles/traumatic-haemothorax">traumatic haemothorax</a>). </p><p>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 <sup>8</sup></p><ul>
- +<li>intrathoracic malignancy<ul>
-<li>soft-tissue tumours <ul><li>sarcomas - <a href="/articles/thoracic-angiosarcomas">thoracic angiosarcomas </a>- +<li>soft-tissue tumours <ul><li>sarcomas: <a href="/articles/thoracic-angiosarcomas">thoracic angiosarcomas </a>
-<a href="/articles/hepatocellular-carcinoma">hepatocellular carcinomas</a> - with thoracic invasion or thoracic metastases</li>-<li>lung cancer is a distinctly <strong>uncommon</strong> cause of haemothorax even in the setting of pleural extension <sup>8</sup>.</li>- +<a href="/articles/hepatocellular-carcinoma">hepatocellular carcinomas</a>: with thoracic invasion or thoracic metastases</li>
- +<li>lung cancer is a distinctly uncommon cause of haemothorax even in the setting of pleural extension <sup>8</sup>
- +</li>
-<li>haematologic abnormalities - coagulopathy<ul><li><a href="/articles/haemophilia">haemophilia</a></li></ul>- +<li>haematologic abnormalities: coagulopathy<ul><li><a href="/articles/haemophilia">haemophilia</a></li></ul>
-<a href="/articles/vascular-ehlers-danlos-syndrome-1">Ehlers-Danlos syndrome (EDS) type IV</a><a href="/articles/vascular-ehlers-danlos-syndrome-1"> </a>- has been associated with hemothorax in the setting of internal mammary artery rupture</li></ul>- +<a href="/articles/vascular-ehlers-danlos-syndrome-1">Ehlers-Danlos syndrome (EDS) type IV</a>: has been associated with hemothorax in the setting of internal mammary artery rupture</li></ul>
-</ul><h4>Treatment and prognosis</h4><h5>Management</h5><p>The exact management strategy with depend on underlying aetiology. In general management options include</p><ul><li>drainage for symptomatic therapy</li></ul><p>For a <strong>clotted</strong> haemothorax - options include</p><ul>- +</ul><h4>Treatment and prognosis</h4><h5>Management</h5><p>The exact management strategy with depend on underlying aetiology. In general management options include:</p><ul><li>drainage for symptomatic therapy</li></ul><p>For a clotted haemothorax options include:</p><ul>
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