Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).
The most common cause of hemothorax is chest (thoracic) trauma. Thoracic injury directly accounts for 20 to 25% of deaths from trauma. Hemothorax can also occur in persons who have:
- Blood clotting defect
- Chest (thoracic) or heart surgery
- Death of lung tissue (pulmonary infarction)
- Lung or pleural cancer -- primary or secondary (metastatic, or from another site)
- Tear in a blood vessel when placing a central venous catheter or when associated with severe high blood pressure
- Chest pain
- Low blood pressure
- Pale, cool and clammy skin
- Rapid heart rate
- Rapid, shallow breathing
- Shortness of breath
Exams and Tests
Your health care provider may note decreased or absent breath sounds on the affected side. Signs or findings of hemothorax may be seen on the following tests:
- Chest x-ray
- CT scan
- Pleural fluid analysis
- Thoracentesis (drainage of pleural fluid through a needle or catheter)
The goal of treatment is to get the patient stable, stop the bleeding, and remove the blood and air in the pleural space. A chest tube is inserted through the chest wall to drain the blood and air. It is left in place for several days to re-expand the lung.
When a hemothorax is severe and a chest tube alone does not control the bleeding, surgery (thoracotomy) may be needed to stop the bleeding.
The cause of the hemothorax should be also treated. In people who have had an injury, chest tube drainage is often all that is needed. Surgery may not be necessary.
WHAT TO EXPECT AT THE EMERGENCY DEPARTMENT
The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The person may receive:
- Breathing support, including oxygen and endotracheal intubation (tube through the nose or mouth into the trachea)
- Blood tests
- Chest tube (tube through the skin and muscles between the ribs into the pleural space (lining of the lungs)) if there is lung collapse
- CAT/CT scan (computerized axial tomography or advanced imaging) of the chest and abdomen
- EKG (electrocardiogram or heart tracing)
- Fluids (intravenous or through the vein)
- Medications to treat symptoms
- X-rays of chest and abdomen
The outcome depends on the cause of the hemothorax, the amount of blood loss and how quickly treatment is given.
If associated with major trauma, the severity of that condition and the rate of bleeding will determine the outcome. When associated with cancer or other conditions, the prognosis of the underlying illness usually will determine the outcome.
- Collapsed lung, leading to respiratory failure (inability to breathe properly, provide the body enough oxygen and remove carbon dioxide)
- Fibrosis or scarring of the pleural membranes
- Infection of the pleural fluid (empyema)
- Associated pneumothorax (air in the pleural cavity, which reduces lung capacity)
When to Contact a Medical Professional
Call 911 if you have:
- Any serious injury to the chest
- Chest pain or shortness of breath
Go to the emergency room or call the local emergency number (such as 911) if you have:
- Dizziness, lightheadedness, fever and cough, or a feeling of heaviness in your chest
- Severe chest, neck, jaw, shoulder or arm pain
- Severe difficulty breathing
Use safety measures (such as seat belts) to avoid injury. Depending on the cause, a hemothorax may not be preventable.
Eckstein M, Henderson SO. Thoracic Trauma. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Mosby; 2013:chap 45.
Light RW, Lee YCG. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 74.
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.