Hemothorax is the accumulation of blood in the pleural cavity or pleural space which is between the chest wall and the lungs. The accumulation of blood in the pleural cavity can cause atelectasis (collapsed lungs).
Though, hemothorax is quite similar to pneumothorax, just that pneumothorax has to do with air in the pleural cavity while hemothorax has to do with blood in the pleural cavity.
Sometimes though, hemothorax may co-exist with pneumothorax, which is now called haemo-pneumothorax. That is, there will be accumulation of both blood and air in the pleural cavity or pleural space.
Note that, hemothorax is usually as a result of chest injury or trauma that may be acquired through a road traffic accident (RTA), gun shot, blunt or penetration to the chest or surgeries.
But hemothorax can also occur spontaneously as a result of cancer(tumor) entering the pleural cavity.
So because of the pressure on the lungs and other parts of the body like the intrathoracic structures, it will then cause incomplete blood clotting which can lead to atelectasis (collapsed lungs) if not attended to immediately, it can result to dyspnea( shortness of breath) or death as the case may be.
Symptoms of Hemothorax
Hemothorax symptoms are due to the loss of blood into the pleural cavity. There can be small or larger hemothoraces.
Symptoms of hemothorax includes;
- Difficulty with breathing: This symptom is most common symptom both in hemothorax and pneumothorax. This is caused by larger hemothoraces which may include breathlessness and dyspnea (shortness of breath).
- Chest Pain: This can also occur during breathing and it is also one of the symptoms of pneumothorax.
- Cyanosis: This is a bluish discoloration of the skin and sclera due to low oxygen content of blood. This happens because the larger hemothoraces has interfered with the transferring of oxygen. This process of low oxygen of blood in the body can lead to rapid heart rate, then also makes the body become pale, cold or damp.
- Fever: This is as a result of the component of the body’s response to the traumatic event.
- Patient may also have cough as a symptom of hemothorax.
- Patient may also have reduction of breath sounds on the affected area.
- Feeling restless, anxious or nervous can also be a symptom of hemothorax.
Causes of Hemothorax
The types of hemothorax can also be base on the causes just as listed in that of “pneumothorax”.
The causes may include;
Traumatic hemothorax is one of the commonest causes of hemothorax which usually causes the pleural membrane lining the lungs or chest to rupture.
Though, traumatic hemothorax is caused by an event like RTA (road traffic accident) or chest injury that can happen either through blunt or penetration.
The chest injury can be as a result of falling with your chest so hard, gun shot wounds, cut, stabbed or penetration of an object directly to the chest. Which might allow blood to leak into the pleural cavity.
Minor wounds, injury or damages to the chest is usually caused by a rupture of the small blood vessel, so the loss of blood is mild.
But when the larger vessel e.g. the aorta is damaged or ruptured, there will be loss of excess blood. The aorta is the largest artery in the human body which is seen on the chest x-ray.
This can also be a cause of hemothorax because it is done by following surgical procedures e.g. passing a central line, lining biopsy, passing a chest tube for other reasons.
Iatrogenic is a surgery that is done either to the lungs or heart that requires opening of the chest wall. It is due to the complications of chest procedure after the surgery is done by the surgeon.
The blood might not clot properly after the surgeon closes the incision or there might be leakage of blood if a vessel is cut open. And these complications can cause hemothorax.
Non-traumatic or Spontaneous hemothorax
The non-traumatic hemothorax has to do with various underlying health conditions. And hemothorax is likely to affect the people with some of the underlying conditions.
Underlying condition such as;
- Lung cancer: This is a tumor in the lungs.
- Lung infection (Tuberculosis)
- Tumor in the chest wall
- Fluids around the lungs
- Blood clot in the lungs.
Diagnosis of Hemothorax
Diagnosis is done to know the disease you have based on the signs and symptoms presented by you to the doctor.
The diagnosis of hemothorax is made largely clinically and also after doing an x-ray, CT scan etc.
This shows that the symptoms are already known or mentioned, the examination of the chest is done to check if there is any stony dull percussion note on the affected side.
There may be tracheal deviation to the opposite side in a very large or massive hemothorax and also a reduction of breath sounds on the affected area.
Also, if it is caused by a trauma and it involves bleeding, you are likely to have features of blood loss which can lead to dizziness, fainting spells, body weakness, unconscious, low blood pressure, rapid pulse rate that is weak. Etc. This can help diagnose hemothorax.
Finally, in the clinical assessment, there is what is called thoracocentesis which is also called thoracentesis. It is the use of needle to puncture the chest.
It is done by yielding or removing of bloody fluids suggested by the pleural cavity.
This shows uniform opacity(whitening). Normally, lungs appear dark on an x-ray not white on the affected side suggesting that fluid(blood) is accumulated in the chest.
Also, shows menisceal sign (air column over water) which may show tracheal deviation and you can see the edges of the heart and chest wall on the affected area because of the whitening(opacity).
This is called blunting of the costophrenic and cardiophrenic angles.
As you may know CT scan is one of the best ways to diagnose a disease because it gives a clear image of the lungs and the pleural cavity. This is essential in cases of injury to know the affected side.
Treatments of Hemothorax
- Treatments can be the passage of a chest tube into the pleural cavity or pleural space to drain out blood. Though, the same tube can be used to expand a collapsed lung, if the tube is left inside the chest for some days.
- Oxygen supplementation: This is the insertion of ventilator tube trough the nose to help with your breathing.
- Analgesic: This is a pain medication that is used for adequate pain control. It is also taken to reduce the pain without being unconscious.
- For those with features of blood loss, they should be given blood (intravenous fluid) and be stabilized by the doctor.
- Chest physiotherapy can also serve as a treatment for hemothorax
Hemothorax is a very serious condition that can lead to death if not treated immediately. If you feel any of the above symptoms, quickly seek a doctor for help or advise.