Hemothorax
Basics
Description
Description
- 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)
Etiology
Etiology
- 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
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Citation
Schaider, Jeffrey J., et al., editors. "Hemothorax." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/all/Hemothorax.
Hemothorax. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/all/Hemothorax. Accessed December 10, 2024.
Hemothorax. (2020). 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 (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/all/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; 2020. [cited 2024 December 10]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307526/all/Hemothorax.
* Article titles in AMA citation format should be in sentence-case
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T1 - Hemothorax
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
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