Treatment of Hemothorax

About the disease

Hemothorax is a condition that causes blood to accumulate in the pleural cavity that surrounds each lung. In most cases, hemothorax is caused by a previous trauma to the chest, which led to a build-up of blood. However, some medical conditions can also cause hemothorax. People who delayed treatment for tuberculosis, are suffering from advanced stages of lung cancer, or who have a blood clotting defect, can also develop hemothorax. In rare cases, blood can build up in the pleural cavity following surgery.

Reported cases of hemothorax date back to ancient times. However, it wasn’t until the 18th century that treatment for this disease was introduced. It usually involved draining blood from the pleural cavity, performed via an open incision into the chest. This treatment was very dangerous and morbidity rates were high. Later on, a more efficient technique was introduced, whereby the blood was drained through a tube.

Symptoms

• Chest pain
• Shortness of breath
• Rapid breathing
• Anxiety as a result of rapid heart beat
• Cool skin, which is also usually pale
• Clammy hands

Diagnosis

• During an initial examination, the doctor will ensure the patient can breathe and see if there has been any damage to the respiratory system.
• The doctor will also measure the patient’s pulse and assess their complexion.
• If the patient coughs up blood, it can also be an indicator of hemothorax.
• The patient’s pleural fluid will be analyzed.
• A chest X-ray, CT scan and other imaging tests can determine whether there is a build-up of blood in the pleural cavity.

Treatment

• A tube is inserted into the chest, to remove the build-up of blood and drain the pleural cavity. After the procedure, the tube will be left in the chest in order to expand the lung and to remove the remaining blood by suction. It is also used to assist the patient’s breathing while they recover.
• If the bleeding is not brought under control following the above drainage technique, a thoracotomy may be necessary. This is a major surgical procedure, whereby an incision is made into the pleural space of the chest.
• If hemothorax was caused by another condition, such as a blood clotting defect, this condition will need to be treated as well.

Authors: Dr. Vadim Zhiliuk, Dr. Sergey Pashchenko