Hämothorax

Hämothorax is the accumulation of blood in the pleural space, typically resulting from injury to chest structures or rupture of vessels within the thorax. Blood in the pleural cavity can compress the lung and, if large, cause hypovolemia or shock.

Causes include traumatic, iatrogenic, and non-traumatic factors. Traumatic hemothorax arises from blunt or penetrating chest injury, rib fractures, or injuries to the lung or intercostal vessels. Iatrogenic causes include thoracentesis, central venous access, thoracic surgery, or cardiopulmonary resuscitation. Non-traumatic causes comprise coagulopathy or anticoagulation, malignancy involving the pleura, ruptured vascular lesions such as aneurysms, and, rarely, spontaneous bleeding.

Patients typically present with chest pain and dyspnea. On examination there may be decreased breath sounds and dullness to percussion on the affected side. Large bleeds can lead to tachycardia, hypotension, and signs of shock. Hemoglobin may decline with ongoing loss.

Diagnosis relies on imaging and laboratory studies. Chest radiography can show a pleural effusion with layering blood; ultrasound excels at rapid detection of pleural fluid. Computed tomography helps identify the bleeding source and associated injuries. Blood tests may reveal anemia and coagulopathy, and pleural fluid is usually grossly bloody.

Management centers on stabilization and drainage. Initial care includes oxygen and establishing IV access. Chest tube thoracostomy is the primary treatment to drain the blood. Transfusion is used for significant blood loss. If drainage is inadequate, there is ongoing bleeding (for example, more than 200 mL per hour or an initial drainage of 1,500–2,000 mL), or clotted blood prevents drainage, surgical intervention with video-assisted thoracoscopic surgery or thoracotomy may be required to evacuate clots and control bleeding. Prognosis depends on bleed volume, cause, and promptness of treatment.