Hemothorax overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Hemothorax as a clinico-pathological entity can be defined in two ways. Morphologically, it is a pathologic collection of blood within the pleural cavity, between the lung surface and inner chest wall. Clinically , hemothorax is defined as a pleural fluid with a hematocrit ranging from at least 25–50% of peripheral blood. In cases of long standing haemothorax due to haemodilution, hemothorax can appear with lower levels of hematocrit. massive hemothorax is defined as the drainage of more than 1500 cc of blood upon chest tube insertion.
Historical Perspective
Haemothorax has been detailed in numerous medical writings dating back to ancient times. In 1794, the first intercostal incision was developed by John Hunter to treat and drainage of the hemothorax. Although Hunter's method was effective in evacuating the hemothorax, an iatrogenic pneumothorax as a result of the procedure was significant. Some recommended closure of chest wounds without drainage. Observing the advantages and dangers of both forms of therapy, Guthrie, in the early 1800s, proposed early evacuation of blood through an existing chest wound. Finally, by the 1870s, early hemothorax evacuation by intercostal incision was considered standard practice.
Classification
Spontaneous haemothorax (SH) is a subcategory of haemothorax.
Pathophysiology
Haemothorax is a pathologic collection of blood within the pleural cavity, between the lung surface and inner chest wall. Three mechanisms of bleeding in haemothorax include torn adhesion between the parietal and visceral pleurae, rupture of neovascularized bullae as a complication of subpleural emphysematous blebs, and torn congenital aberrant vessels branching from the cupola and distributed in and around the bulla in the apex of the lung. There are some genetic disorder that are predisposed to haemothorax.
Causes
Haemothorax may be caused by trauma or can be spontaneous and iatrogenous. Causes of traumatic haemothorax include blunt force injuries ,penetrating thoracic injuries, and thoracoabdominal injuries. Causes of spontaneous haemothorax include vascular disorders, malignancies, connective tissue disorders, gynecological disorders, hematological disorders, and miscellaneous pathological entities. Haemothorax can also be a complication of various iatrogenically-related procedures.
Differentiating [disease name] from other Diseases
Haemothorax must be differentiated from other diseases that cause dyspnea such as pleural effusion, chylothorax, pneumothorax.
Epidemiology and Demographics
The exact incidence of haemothorax is not clear. Chest injuries occur in approximately 60% of all polytrauma cases and haemothorax is most frequently caused by chest trauma. The occurrence of haemothorax related to trauma in the United States is estimated to be 300,000 cases annually.
Age
- Patients of all age groups may develop [disease name].
Gender
- [Disease name] affects men and women equally.
Race
- There is no racial predilection for [disease name].
Risk Factors
Common risk factor in the development of hemothorax is trauma. Non-traumatic hemothorax is a relatively uncommon entity.
Natural History, Complications and Prognosis
Bleeding into the pleural space is exposed to the motion of the diaphragm, lungs, and other intrathoracic structures. The agitation of cardiac and respiratory movement defibrinates the blood, and a fibrin clot thus formed is deposited on the layers of pleura. After several hours, clot formation is inevitable and it should be evacuated. if left untreated, it may progress to develop some complications.
Diagnosis
Symptoms
- Symptoms of hemothorax may include the following:
- severe chest pain
Physical Examination
- Physical examination may be remarkable for:
- dullness to percussion
- decreased breath sounds
- dyspnea
- hypovolemic shock
- trachea deviation
Laboratory Findings
- There are no specific laboratory findings associated with [disease name].
- A [positive/negative] [test name] is diagnostic of [disease name].
- An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
- Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
Imaging Findings
- There are no [imaging study] findings associated with [disease name].
- [Imaging study 1] is the imaging modality of choice for [disease name].
- On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
- [Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
Treatment
Medical Therapy
Surgery
Primary Prevention
Use safety measures (such as seat belts) to avoid injury. Depending on the cause, a hemothorax may not be preventable.