A hemothorax is a condition in which blood collects in the space between the lungs and the chest wall. This can occur as a result of an injury to the chest, or it may be a complication of a medical procedure.
In this article, we will provide an overview of a hemothorax, including its symptoms, diagnosis, and treatment.
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What is a Hemothorax?
A hemothorax is a condition characterized by a collection of blood in the pleural cavity, which is the space between the lungs and the chest wall.
When this occurs, it can result in several complications, including difficulty breathing and impaired gas exchange.
Causes
There are several possible causes of a hemothorax, including:
- Blunt trauma
- Penetrating chest wound
- Cancer
- Pleural tumor
- Complication from thoracic surgery
- Ruptured blood vessel
The most common cause of a hemothorax is a traumatic thoracic injury; however, it can also occur due to any of the other processes listed above.
Signs and Symptoms
The signs and symptoms of a hemothorax will depend on the underlying cause. However, some common examples include:
- Dyspnea
- Chest pain
- Tachycardia
- Hypertension
- Shallow breathing
- Restlessness
- Anxiety
- Restlessness
- Cold or clammy skin
- Diminished breath sounds on the affected side
The symptoms of a hemothorax may vary for each patient, depending on the severity of their condition.
Treatment
The most common treatment method for a hemothorax involves removing blood from the pleural space. This requires the insertion of a chest tube, which is a thin tube that is inserted through the ribs.
The chest tube works by draining the blood from the pleural cavity and into a collection chamber. Once the chest tube is in place, the patient will be monitored closely for any complications.
Blood from the pleural cavity can also be removed by a process known as a thoracentesis. This involves the insertion of a large needle into the pleural space that can remove up to three liters of fluid.
After the blood has been removed, it’s important to monitor the patient for any signs of reaccumulation. Medical professionals should also strive to diagnose and treat the underlying cause of the hemothorax.
Hemothorax Practice Questions:
1. What is a hemothorax?
It is an accumulation of blood in the pleural space.
2. What will the general appearance of patients with hemothorax be?
Cyanotic, tracheal deviation/mediastinal shift away from the affected area, and bruising over the affected area.
3. What will the respiratory pattern look like for patients with hemothorax?
Tachypnea and a productive cough (hemoptysis).
4. What type of breath sounds will you hear for patients with hemothorax?
Diminished or absent on the affected side.
5. What will the chest percussions for patients with hemothorax?
Flat/dull percussion note on the affected side and decreased tactile and vocal fremitus.
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6. What type of diagnostic testing should be done for a hemothorax?
Chest x-ray, ABG, and CBC.
7. What will the chest x-ray look like for a hemothorax?
Increased radiodensity, increased whiteness, and a tracheal shift away from the affected side.
8. What will the ABG look like for patients with hemothorax?
Acute alveolar hyperventilation with hypoxemia.
9. What will the CBC be like for a hemothorax?
Reduced RBC Hbg Hct.
10. What is the treatment for a hemothorax?
Thoracentesis or chest tube to drain blood, oxygen for hypoxemia, hyperinflation therapy and MV with PEEP for acute vent failure.
11. What is the etiology of a hemothorax?
Blood accumulation in the space between the chest wall and lung (pleural cavity), often caused by trauma but is also frequent complication following cardiac or thoracic surgery.
12. What is the chief complaint of a hemothorax?
Shortness of breath and chest pain.
13. What would the physical exam be like for a hemothorax?
Decreased breath sounds.
14. How is a hemothorax diagnosed?
Chest x-ray.
15. What is the past medical history of patients with hemothorax?
Severe chest pain.
16. What are the vital signs for a hemothorax?
Elevated heart rate and blood pressure.
17. What cough is manifested by patients with hemothorax?
A productive cough (hemoptysis).
18. What is the appearance of the chest for a hemothorax patient?
Tracheal and/or mediastinal shift away from the affected side, bruising over the affected area.
19. What is the hemothorax respiratory pattern?
Tachypnea and dyspnea depending on severity.
20. What is the color of patients with hemothorax?
Cyanotic.
21. What are the typical breath sounds for a hemothorax?
Diminished or absent on affected side, possibly pleural friction rub.
22. What assessment data would indicate that the chest tubes have been effective in treating a patient with a hemothorax who has a right-sided chest tube?
There is gentle bubbling in the suction compartment. There is no fluctuation in the water-seal compartment. There is 250 mL of blood in the drainage compartment. The client is able to deep breathe without any pain.
23. What is the overview for a hemothorax?
Blood in the pleural cavity and may result in lung collapse.
24. What is the pathophysiology of a hemothorax?
Damaged intercostal, pleural, mediastinal, and sometimes lung parenchymal vessels cause blood to enter the pleural cavity. The amount of bleeding and the cause is associated with varying degrees of lung collapse and mediastinal shift.
25. What are the causes of a hemothorax?
Anticoagulant therapy, blunt or penetrating chest trauma (most common cause), central venous catheter insertion, damaged intercostal, pleural, or mediastinal vessels; damaged parenchymal vessels, dissecting thoracic aneurysm, heart or thorax surgery, hereditary hemorrhagic telangiectasia, necrotizing infections, neoplasm, pulmonary arteriovenous fistulas, pulmonary infarction, thoracic endometriosis and tuberculosis.
26. What is the incidence of a hemothorax?
Hemothorax occurs in approximately 300,000 cases of trauma per year.
27. What are the complications of a hemothorax?
Mediastinal shift, ventilatory compromise, lung collapse, cardiopulmonary arrest, pneumothorax
28. What is the patient history of a hemothorax?
Recent trauma, recent thoracic surgery, metastatic disease, chest pain and dyspnea.
29. What are the physical findings of a hemothorax?
Tachypnea, dusky skin color, diaphoresis, hemoptysis, restlessness, anxiety, cyanosis, stupor, affected side may expand and stiffen. The unaffected side may rise with gasping respirations, dullness over the affected side, decreased or absent breath sounds over the affected side. Symptoms associated with blunt trauma such as bruising, tachycardia and hypotension.
30. What diagnostic laboratory results would be found in patients with hemothorax?
Pleural fluid analysis shows hematocrit greater than 50% of serum hematocrit. Arterial blood gas (ABG) analysis may show the increased partial pressure of carbon dioxide and decreased partial pressure of oxygen. Serum hemoglobin level may be decreased, depending on blood loss.
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31. What diagnostic imaging results would be found in patients with hemothorax?
Chest X-rays and computed tomography scan of the thorax show presence and extent of hemothorax and help to evaluate treatment.
32. What would the results of a thoracentesis be for a patient with a hemothorax?
Thoracentesis may yield blood or serosanguineous fluid.
33. What are the treatment methods for a hemothorax?
Stabilization of the patient’s clinical condition, stoppage of bleeding, thoracentesis, insertion of a chest tube and auto-transfusion if blood loss approaches or exceeds 1.
34. What medications should be given for a hemothorax?
Oxygen, analgesics, and IV fluid therapy.
35. What are the expected outcomes of a hemothorax?
Express feelings of increased comfort and decreased pain. Express feelings of reduced anxiety. Maintain fluid volume balance. Maintain adequate ventilation and oxygenation. Maintain effective breathing pattern. Maintain adequate cardiopulmonary perfusion. Remain free from signs and symptoms of infection.
36. How should the respiratory therapist help treat patients with a hemothorax?Recommend analgesics as ordered. Institute comfort measures and help the patient relax. Auscultate lung sounds for changes. Give prescribed oxygen based on oxygen saturation levels. If indicated, assist with chest tube insertion, ensure the tube is attached to a closed drainage system, and arrange for chest X-rays to evaluate chest tube location. Ensure follow-up chest X-ray after removal of
37. What should be monitored on patients with hemothorax?
Vital signs, intake, and output, chest tube drainage, cardiopulmonary status, closed drainage system function, hemodynamic parameters, ABG results, chest X-ray results, CBC results, complications and signs and symptoms of infection.
38. What causes blood in the pleural space?
Trauma.
39. What will be the suspicion for patients with severe chest pain after a trauma?
Hemothorax.
40. How will the tactile and vocal fremitus be for a hemothorax?
Vibration on talking will be decreased.
41. Is there a pleural friction rub on patients with a hemothorax?
Yes, it might be heard since the pleural space will be filled with blood.
42. What is used to drain fluid from the lungs?
Thoracentesps.
43. When assessing a patient with a hemothorax, you will most likely find:
You will most likely find signs and symptoms of shock.
44. A moderate hemothorax diagnosis would be confirmed by the presence of which of the following?
Blood filling approximately one-third of the pleural space.
45. What is the treatment of a hemothorax and pneumothorax?
Recommend a chest tube or thoracentesis in order to drain blood from the pleural space.
46. Which of the following assessment findings would you expect with a hemothorax?
Chest pain, dyspnea, and tachycardia.
47. Is there a tracheal shift when a hemothorax is present?
Yes, the trachea will shift away from the affected side.
48. What is the diagnostic percussion note for a hemothorax?
Chest percussion would show a dull percussion note.
49. What will the chest x-ray show for a hemothorax?
Partial or complete opacification of the affected side of the thorax.
50. Is mechanical ventilation recommended for a hemothorax?
If ventilatory failure is present— yes, mechanical ventilation would be indicated.
Final Thoughts
A hemothorax is a condition characterized by the accumulation of blood in the pleural cavity. This can be a result of blunt trauma, cancer, or a complication from surgery.
The most common symptom of a hemothorax is dyspnea, but it can also cause chest pain, tachycardia, and hypertension. The treatment involves the insertion of a chest tube to drain blood from the pleural space.
If you found this information helpful, be sure to check out our pneumothorax study guide. Thanks for reading and, as always, breathe easy, my friend.
Written by:
John Landry, BS, RRT
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- Jardins, Des Terry. Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. 7th ed., Cengage Learning, 2019.
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019
- Broderick, Stephen. “Hemothorax: Etiology, Diagnosis, and Management.” PubMed, Feb. 2013, pubmed.ncbi.nlm.nih.gov/23206720.
- “Management and Outcomes of Traumatic Hemothorax in Children.” PubMed Central (PMC), 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4411582.
- Boersma, Wim. “Treatment of Haemothorax.” PubMed, 2010, <p; tab-interval=”36pt”>Boersma, Wim. “Treatment of Haemothorax.” PubMed, 2010, pubmed.ncbi.nlm.nih.gov/20817498..