What Is a Hemothorax?

Hemothorax refers to the accumulation of whole blood in the thoracic cavity, also known as pleural hemorrhage. The most common cause is trauma or surgery. Internal medicine is common in empyema and tuberculosis infections, as well as tumors in the pleura or lung, and disorders of the coagulation mechanism. The clinical manifestations of hemothorax vary depending on the amount and speed of blood accumulation in the chest, and the patient's physique. Acute blood loss may appear symptoms of hypovolemic shock such as pale, rapid pulse, shortness of breath, and gradual decrease in blood pressure.

Basic Information

nickname: Pleural hemorrhage
English name: hemothorax
Visiting department: Thoracic Surgery
Common causes: Most hemothorax is caused by penetrating or blunt chest trauma. Non-traumatic hemothorax is rare and can be secondary to chest or systemic diseases.

Common symptoms: Hypovolemic shock symptoms such as pale, rapid pulse, shortness of breath, and gradual decrease in blood pressure, etc.

Causes of hemothorax

According to different causes and mechanisms of hemothorax, hemothorax can be divided into traumatic hemothorax and non-traumatic hemothorax. Most hemothoraxes are caused by penetrating or blunt chest trauma. Penetrating or blunt injuries to the chest wall, lungs, large blood vessels in the chest, or the heart can cause hemorrhage in the pleural space called traumatic hemothorax, and when pneumothorax is present, traumatic hemopneumothorax. Non-traumatic hemothorax is also called spontaneous hemothorax. Patients have no history of trauma, and sometimes may have cough, increased abdominal pressure, weight bearing, fatigue, exercise, and sudden change of position. Non-traumatic hemothorax is rare and can be secondary to chest or systemic diseases, and very few can't find a clear cause of bleeding. According to its etiology, it can be divided into idiopathic hemothorax, infectious hemothorax, and endometriosis, which can also cause hemothorax and other reasons.

Hemothorax clinical manifestations

Hemothorax varies depending on the amount of blood in the chest, the speed, and the physique of the patient. A small amount of hemothorax (less than 500ml) had no obvious clinical symptoms, and a chest radiograph showed that the costosacral angle disappeared. Moderate hemothorax (not more than 1000ml) and large hemothorax (more than 1000ml), especially acute blood loss, may appear symptoms of hypovolemic shock such as pale, rapid pulse, shortness of breath, and gradual decrease in blood pressure. Shock manifested as weak pulse, decreased blood pressure, and shortness of breath. When concurrent infections occur, symptoms such as high fever, chills, fatigue, and sweating appear.

Hemothorax

Blood routine

Peripheral red blood cells of patients with major hemorrhage decreased significantly, and hemoglobin also decreased significantly.

2.X-ray chest radiograph

When the blood volume is less than 200ml, the X-ray is difficult to make a diagnosis. When the volume of blood is more than 500ml, the costosacral angle becomes dull, and the liquid level of the costosacral angle can be seen when pneumothorax is combined. Lying radiographs are often omitted, and should be taken in an upright position, and follow-up X-rays should be performed regularly (6, 24 hours after injury). When the volume of blood is about 1000ml, the shadow of the effusion reaches the lower scapular plane. When the blood volume exceeds 1500ml, the shadow of the effusion exceeds the hilar level, and even shows a dense shadow of the whole chest and a mediastinal displacement.

3. Ultrasound

Visible level section. A thoracentesis can confirm a diagnosis when non-coagulated blood is drawn. It is not easy to draw blood or the amount is small during coagulative hemothorax. Internal bleeding symptoms worsened, and X-rays showed an increase in fluid volume. When the clinical symptoms are serious, a physical examination is performed first to establish a diagnosis of thoracentesis, without waiting or simply not performing an X-ray chest examination first.

Hemothorax diagnosis

Have a history of chest trauma (including iatrogenic), spontaneous hemothorax has cough, increased abdominal pressure, weight bearing, fatigue, exercise, sudden change of body position, etc., has corresponding clinical manifestations and chest radiograph results, and can generally be made diagnosis. Thoracocentesis is a clear diagnosis.

Hemothorax differential diagnosis

Hemothorax should be distinguished from pneumothorax, hemopneumothorax, diaphragmatic rupture, old pleural effusion, and traumatic chylothorax.

Hemothorax complications

Hemothorax is prone to pneumothorax and pneumothorax. If the hemothorax is not handled in time, it can cause complications such as dyspnea, shock, chest infections, and coagulative hemothorax.

Hemothorax treatment

Non-progressive bleeding

A small amount of hemothorax can be absorbed by itself without special treatment, and it should be closely observed for progressive bleeding. If the amount of blood is large, chest puncture or closed drainage of the chest cavity should be performed as soon as possible to drain the blood and promote lung expansion. Use antibiotics to prevent infection.

2. Progressive bleeding

While rehydration, transfusion, and correction of hypovolemic shock, timely thoracoscopy or thoracotomy should be performed to find the bleeding site and provide suture to stop bleeding.