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.
It usually occurs from penetrating or blunt trauma 3 to the chest (traumatic haemothorax).
A haemothorax can also result without any trauma and, in these situations, it is termed a spontaneous haemothorax. This can occur in the setting of 8 :
- intrathoracic malignancy
- usually occurs with thoracic wall tumours
- soft-tissue tumours
- sarcomas: thoracic angiosarcomas
- hepatocellular carcinomas: with thoracic invasion or thoracic metastases
- lung cancer is a distinctly uncommon cause of haemothorax even in the setting of pleural extension 8
- spontaneous pneumothorax - spontaneous haemopneumothorax
- anticoagulant medication
- vascular rupture
- aortic dissection
thoracic arteriovenous malformations
- thoracic endometriosis
- pulmonary infarction
- pleural adhesions with pneumothorax
- haematologic abnormalities: coagulopathy
- connective tissue disease
- Ehlers-Danlos syndrome (EDS) type IV: has been associated with haemothorax in the setting of internal mammary artery rupture
- congenital bony exostoses
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.
May have a very high sensitivity (92%), specificity (100%) positive predictive values (100%) and negative predictive values (98%) in detection of a haemothorax the context of preceding trauma 2.
CT is useful in determining the nature of the 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.
Recognised complications that can after a retained haemothorax include 7
Treatment and prognosis
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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