The following systemwise presentation of signs and symptoms is seen in patients suffering from hemothorax:
A good clinical history and physical examination may easily seal the diagnosis of hemothorax. However, these laboratory tests and examinations may prove to be helpful in the definitive diagnosis and the management of the hemothorax:
Patients presenting in the emergency room with signs of hemothorax should be dealt with promptly. The stabilization of the cardiopulmonary status is given utmost priority followed by the prompt evacuation of the collected blood and pneumothorax in the pleural space. The application of a tube thoracostomy in patients with hemothorax remains to be the primary mode of treatment.
The use of a Video Assisted Thoracoscopic Surgery (VATS) allows the direct removal of clots in the pleura and the precise placement of the chest tubes. VATS may also be used in the direct ligation of chest bleeders to control the progression of hemothorax in some cases . Even in late cases of retained clots, VATS may prove to be useful to evacuate these clots when the patient is already stabilized .
In cases of non-traumatic hemothorax, the open thoracotomy approach may prove to be indispensable. This procedure is most useful in the following intrathoracic surgical procedures: stapling of bullous lesions, resection of cavitary diseases and necrotic lung tissue, sequestration of arterio-venous malformation, and repair of aortic aneurysm .
Residual pneumothorax is treated by fibrinolysis through the chest tube using streptokinase or urokinase in saline solution . The regular instillation of fibrinolytic compounds in the pleura carries a success rate of up to 92%.
In general, the outcome for traumatic hemothorax is good due to the advances in the health care delivery. Mortality rates in hemothorax varies directly to the severity of the thoracic injury and the important structures involved therein. Retained hemothorax, empyema and fibrothorax is associated with poor morbidity rating. The prompt surgical evacuation of the retained hemothorax is associated with an excellent prognosis.
The following medical conditions are known to be the common complications of hemothorax:
In the United States, the number of hemothorax cases related to chest trauma approximates 300,000 cases per year . Statistics in a trauma center have confirmed that the relative mortality rate of hemothorax among children reaches 57.1% in blunt chest trauma . In penetrating chest injuries, morbidity was slated at 8.51% complicating to either atelectasis, lung infection, intrathoracic hematoma, wound infection, pneumothorax, or sepsis .
The pathophysiology of hemothorax is governed by two basic responses namely: the hemodynamic response, and the respiratory response. Any disruption in the integrity of the chest wall to the lung parenchyma may cause significant bleeding that can fill the pleural space. Given that the pleural cavity can hold up to 4 liters of fluids, an occult exsanguination of blood can cause hypovolemic shock to a patient without eminent bleeding from the outside. Shock can occur if blood loss amounts to more than 30% of the blood volume or approximately 1,500 ml in a 70kg man.
Early symptoms of shock includes tachypnea, tachycardia and decreased pulse pressure. While the blood collects in the pleural space, the lung parenchyma is consequently displaced and unable to expand effectively. The significant impairment in the oxygen exchange in the lungs due to the collection of blood constitutes the respiratory response phase of the hemothorax.
Traumatic hemothorax can be prevented by avoiding activities that may lead to blunt injuries to the chest wall. Seat belts must always be in place while driving. Drivers must cautiously drive motorcycles and bicycles to avoid road accidents. Patients diagnosed with tuberculosis must submit to immediate treatment and constant chest X-ray monitoring to prevent spontaneous hemothorax and pneumothorax .
Hemothorax is a clinical condition characterized by the presence of blood between the chest wall and the lung parenchyma (pleural space). The hemorrhage in hemothorax may originate from the lung parenchyma, the great vessels, the heart or the chest wall.
Hemothorax is usually caused by blunt trauma to chest wall but may infrequently be due to diseases conditions, iatrogenic induction or spontaneous . Hemothorax needs immediate evacuation to prevent life threatening complications. To this day, the use of trocar and cannula through an incision in the chest wall to drain the blood and trapped air is still the standard practice .
Hemothorax is defined as a clinical condition characterized by the presence of blood in the pleural space.
A thorough clinical history and physical examination. Ancillary procedures like laboratory pleural fluid analysis and imaging techniques may also be implored.
Treatment and follow-up
Tube thoracostomy remains to be the primary mode of treatment, Open thoracotomy may also be an option, the use of VATS for hemothorax evacuation in stabilized patients may also be done, and pleural fibrinolysis may also be done to eliminate the residual pneumothorax.