Haemothorax

Haemothorax literally means blood within the chest, is a term usually used to describe a pleural effusion due to accumulation of blood. If a haemothorax occurs concurrently with a pneumothorax it is then termed a haemopneumothorax

A tension haemothorax refers to haemothorax that results from massive intrathoracic bleeding, causing ipsilateral lung compression and mediastinal displacement 9.

A haemothorax is sometimes defined by pleural fluid with a haematocrit > 50% of the blood haematocrit.

Causes

It usually occurs from penetrating or blunt trauma 3 to the chest (traumatic haemothorax). 

A haemothorax can also result without any antecedant trauma and in these situations it is termed a spontaneous haemothorax. This can occur in the setting of 8

Plain radiograph

Chest radiographic appearance of a large haemothorax may be similar to that of pleural effusion. It can be almost impossible to differentiate a haemothorax from other causes of pleural effusions.

Ultrasound

May have very high sensitivity (92% 2), specificity (100% 2) positive predictive values (100%2) and negative predictive values (98%2) in detection of a haemothorax the context of preceding trauma.

CT

CT is useful in determining the nature of pleural fluid in the setting of trauma by assessing the attenuation value. Blood in the pleural space typically has an attenuation of 35-70 HU 6. Pleural fluid attenuation measurement should be routine in the interpretation of chest trauma CT to distinguish simple fluid from acute blood.

In the setting of trauma, there may be other ancillary features such as pulmonary contusions and lacerations.

Recognised complications that can after a retained haemothorax include 7

Management

The exact management strategy will depend on underlying aetiology. In general management options include:

  • drainage for symptomatic therapy

For a clotted haemothorax options include:

  • video assisted thoracoscopic surgery (VATS)
  • intrapleural fibrinolytic therapy (IPFT)
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Article Information

rID: 24341
System: Chest
Section: Gamuts
Tag: cases
Synonyms or Alternate Spellings:
  • Haemothoraces
  • Hemothorax
  • Hemothoraces

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