Emergency Central is a collection of disease, drug, and test information including 5-Minute Emergency Medicine Consult, Davis’s Drug, McGraw-Hill Medical’s Diagnosaurus®, Pocket Guide to Diagnostic Tests, and MEDLINE Journals created for emergency medicine professionals. Explore these free sample topics:
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- 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