Hemothorax - Causes and Symptoms

Definition

Hemothorax is the shedding of blood within the pleural space (ie between the two membranes that line the lungs and the chest wall).

It manifests itself with the appearance of acute chest pain, followed by respiratory difficulties, tachycardia, hypotension and cyanosis. If the bleeding is severe, the hemothorax can cause the death of the patient in a few minutes (hemorrhagic shock), therefore the treatment must be timely.

The less severe forms require the emptying of the collection of blood from the pleural space by means of a catheter or thoracostomy drain, transfusions, administration of coagulating drugs and therapeutic measures designed to combat shock and anemia. If bleeding comes from a laceration, pleurodesis (artificial obliteration of the two pleural sheets) should be considered. If bleeding is massive, an emergency thoracotomy may be necessary.

The blood accumulation in the pleural cavity is most commonly caused by penetrating thoracic wounds and closed traumas (eg bruises, chest compression and rib fracture), which determine the lesion of the lung parenchyma and the rupture of vessels of a certain caliber (eg aorta or pulmonary artery).

Sometimes the hemorrhagic effusion is the consequence of invasive medical procedures that accidentally damage the pleurae (eg transthoracic needle aspiration, thoracentesis, central venous catheter placement and cardiopulmonary resuscitation).

The non-traumatic hemothorax is found, instead, in the case of pulmonary infarction, rupture of pleural adhesions and blood coagulation disorders. Various other morbid processes are capable of causing erosion or rupture of blood vessels with pathological blood collection between the pleurae: bullous emphysema, tuberculous foci, aneurysm, pulmonary cysts and pleural endometriosis.

Other causes of hemothorax include primitive and metastatic neoplasms of the pleura and lung.