HEMOTHORAX – Etiology, Pathophysiology, Signs and Symptoms, Diagnostic Evaluation and Management
A hemothorax is a condition that results from blood accumulating in the pleural cavity.
ETIOLOGY
- Penetrating trauma
- Blunt trauma
- Broken ribs
- Shearing forces
- Violet compression of pleural cavity
PATHOPHYSIOLOGY
Due to trauma (blunt or penetrating injury) to the thorax (resulting in) —- rupture of the serious membrane or covering the lungs (this rupture allows) —- blood to spill into the pleural space (leading to) —- hemothorax
SIGNS AND SYMPTOMS
- Tachypnea
- Dyspnea
- Cyanosis
- Decreased or absent breath sounds on affected side
- Tracheal deviation to unaffected side
- Dull resonance on percussion
- Unequal chest rise
- Tachycardia
- Hypotension
- Pale, cool, clammy skin
- Possibly subcutaneous emphysema
- Narrowing pulse pressure
DIAGNOSTIC EVALUATIONS
- Chest X-ray
- CT scan
- Pleural fluid analysis
- Thoracentesis
MANAGEMENT
- Thoracostomy: a hemothorax is managed by removing the source of bleeding and by draining the blood already in the thoracic cavity. Blood in the cavity can be removed by inserting a drain (chest tube) in a procedure called tube thoracostomy
- Thrombolytic agents have been used to break up clot in tubes or when the clot becomes organized in the pleural space. However, this is risky as it can lead to increased bleeding and the need for reoperation
COMPLICATIONS
- Collapsed lung, leading to respiratory failure
- Death
- Fibrosis or scarring of the pleural membranes
- Infection of the pleural fluid (empyema)
- Pneumothorax
- Shock
