Hemothorax
| Hemothorax | |
|---|---|
| Classification and external resources | |
| Specialty | emergency medicine |
| ICD-10 | J94.2, S27.1 |
| ICD-9-CM | 511.8, 860 |
| DiseasesDB | 19762 |
| MedlinePlus | 000126 |
| eMedicine | med/2915 ped/971 |
| MeSH | D006491 |
A hemothorax ( + thorax) (or haemothorax or haemorrhagic pleural effusion) is a type of pleural effusion in which blood accumulates in the pleural cavity. This excess fluid can interfere with normal breathing by limiting the expansion of the lungs.
Hemothorax tends to occur following blunt or penetrating trauma to the thorax or thoracoabdominal area. It may also follow thoracic surgery, or may be spontaneous. Chest pain, dyspnea, and tachypnea are common presenting features. Other symptoms of hemothorax are dependent on the mechanism of injury, but may include:
Its cause is usually traumatic, from a blunt or penetrating injury to the thorax, resulting in a rupture of the serous membrane either lining the thorax or covering the lungs. This rupture allows blood to spill into the pleural space, equalizing the pressures between it and the lungs. Blood loss may be massive in people with these conditions, as each side of the thorax can hold 30 to 40% of a person's blood volume. Even minor injury to the chest wall can lead to significant hemothorax.
Less frequently, hemothorax occurs spontaneously. A major vascular cause of hemothorax is aortic dissection or rupture of thoracic aortic aneurysms. It may also follow surgical intervention in the thoracic area. Infrequently, patients with pneumothorax may develop spontaneous hemothorax. Spontaneous hemothorax or hemopneumothorax may be occur with endometriosis, if endometrial tissue implants on the pleural surface, then bleeds in response to cyclical hormonal changes in menstruating women.
The thoracic cavity is a chamber within the chest, containing the lungs, heart, and numerous major blood vessels. The parietal pleura lines the chest wall, while the visceral pleura covers the outside of the lungs. The visceral and parietal pleura are separated by a thin layer serous fluid. When a hemothorax occurs, blood enters the pleural cavity, which normally only contains a small amount of pleural fluid. As blood builds up within the pleural cavity, it begins to interfere with the normal movement of the lungs, resulting in dypsnea, poor ventilation, and abnormal oxygenation.
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