- Accumulation of blood in the intrapleural space after blunt/penetrating chest trauma or other nontraumatic etiology. Bleeding is usually a result of disruption of the tissues/vessels of the chest wall, pleura, or intrathoracic structures:
- Results in decreased vital capacity, hypoxia, and respiratory compromise
- Loss of large intravascular volume results in hemodynamic instability and hemorrhagic shock
- Massive hemothorax can cause increased intrathoracic pressure, resulting in compromised venous return and decreased cardiac output
- Rarely a solitary finding in blunt trauma:
- Commonly associated with pneumothorax (25% of cases), extrathoracic injuries (73% of cases), and pulmonary contusion
- Large hemothoraces cause the release of substances that can act as anticoagulants and contribute to continued intrathoracic bleeding
- If left untreated, can lead to empyema and fibrothorax (lung trapping due to adhesions)
- Traumatic injuries (including iatrogenic) to major blood vessels:
- Common vessels, including intercostal artery, internal mammary artery, pulmonary artery, pulmonary vein, aorta, vena cava, and heart are associated with hemorrhage into the thoracic cavity
- Traumatic lung parenchymal injuries:
- Often stops spontaneously as a result of low pulmonary pressures and high concentrations of thromboplastin in the lung
- Often associated with pneumothorax
- Nontraumatic or spontaneous hemothoraces:
- Very rare
- Consider coagulation disorder, malignancy, primary vascular event (such as aortic dissection, ruptured aneurysm), PE with infarction, infection (TB), bullous emphysema, pulmonary AV malformation, lobar sequestration
- Torn pleural adhesions as a complication of spontaneous pneumothorax or tube thoracostomy
There's more to see -- the rest of this topic is available only to subscribers.
Schaider, Jeffrey J., et al., editors. "Hemothorax." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/1.3/Hemothorax.
Hemothorax. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/1.3/Hemothorax. Accessed May 29, 2023.
Hemothorax. (2016). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (5th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/1.3/Hemothorax
Hemothorax [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2023 May 29]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/1.3/Hemothorax.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hemothorax ID - 307526 ED - Barkin,Adam Z, ED - Shayne,Philip, ED - Rosen,Peter, ED - Schaider,Jeffrey J, ED - Barkin,Roger M, ED - Hayden,Stephen R, ED - Wolfe,Richard E, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/1.3/Hemothorax PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -