Hemothorax

Hemothorax:  In this disorder, blood from damaged intercostal , pleural , mediastinal, and sometimes lung parenchymal vessels enters the pleural cavity.  Depending on the amount of bleeding and the underlying cause, hemothorax may be associated  with varying degrees of lung collapse and mediastinal shift. Pneumothorax (air in the pleural cavity) commonly accompanies hemothorax.

Cause:  Usually results from blunt or penetrating chest trauma.  Hemothorax may result from thoracic surgery, pulmonary infarction, neoplasm, disecting thoracic aneurysm, or anticoagulant therapy.

Symptoms:

Percussion reveals dullness, and auscultation reveals decreased to absent breath sounds over the affected side.

Chest pain
Tachypnea
Mild to severe dyspnea (difficulty breathing) may be present

If respiratory failure results, the patient may appear anxious, restless, possibly stuporous, and cyanotic.

Marked blood loss produces hypotension and shock.

The affected side of the chest expands and stiffens, while the unaffected side rises and falls with the patient's gasping respirations

Treatment:

Goal:  to stabilize the patient's condition, stop the bleeding, evacuate blood from the pleural space, and reexpand the underlying lung.

Mild hemothorax usually clears in 10 to 14 days, requiring only observation for further bleeding.

In severe hemothorax, thoracentesis may be performed, (not only use as a diagnostic tool, but also as a method of removing fluid from the pleural cavity.)

Chest tube
Suction may be used to prevent clot blockage

Thoracotomy may be done to evacuate blood and clots and to control bleeding.

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