Haemothorax

HAEMOTHORAX, haematothorax, hemothorax (from Greek haima - blood and thorax - chest), accumulation of blood in the pleural cavity. Haemothorax develops 1) as a result of trauma to the chest wall, pleura, lung, and mediastinum, or 2) as a result of a disease thereof leading to a disruption of the integrity of the blood vessels contained within them with subsequent hemorrhage (tuberculosis, aneurysm, neoplasms, and the like), or 3) as a result of a bleeding diathesis in general in such diseases as scurvy, various types of purpura, and the like. Haemothorax is most frequently observed in chest wounds caused by firearms or cold steel weapons. Relatively small lung wounds can produce massive hemorrhages due to the presence of negative pressure in the pleura and constant respiratory movements. The closer the wound is to the root of the lung, the more serious the hemorrhage is. The amount of extravasated blood can vary: from a few cubic centimeters to several liters. Depending on the amount of blood poured out, compression of the lung and displacement of the chest organs may be observed. The escaped blood sometimes undergoes coagulation rather quickly; more often, however, coagulation is delayed, and for a long time mobile fluid—defibrinated blood—can be ascertained in the pleural cavity, since fibrin is deposited on the surface of the pleura. If the fibrin does not lead to adhesion between the layers of the pleura, the dullness in the latter case, in terms of mobility and the configuration of its borders, has the same character as in hydrothorax. Symptoms and course. Most commonly observed are shock, shortness of breath, cough, and sometimes hemoptysis, moderate fever, and increased pulse rate. In the absence of complications and with moderate accumulations of blood, these disorders gradually subside due to the resorption of the extravasated blood, and patients recover fairly soon (4–6 weeks). Local phenomena in the form of weakened breathing and pleural friction rub may sometimes persist for a considerable time. In massive hemorrhages from aneurysms or a large branch of the pulmonary artery, collapse and death rapidly ensue. Complications boil down mainly to the addition of septic infection. In this case, fever increases, cough continues and intensifies, exudate builds up, and the general condition progressively deteriorates. Sometimes pneumonia, pulmonary gangrene, pericarditis, and so forth develop, as well as general sepsis. Physical signs are the same as in exudative pleurisy and depend on the amount of fluid poured out. Prognosis depends on the cause that provoked the hemorrhage, the amount of blood extravasated, and subsequent complications. Wounds of the pulmonary vessels or their large branches almost as a rule lead to death (S. Jacobson). Treatment. In uncomplicated forms of haemothorax, intervention is limited to bed rest for the patient, rational care, and the use of symptomatic therapy. In significant hemorrhages, intravenous infusion of saline solution is required. With large accumulations, replacement of part of the fluid with oxygen is useful. Complications require appropriate therapeutic intervention. In suppuration of the pleural contents, surgical treatment is indicated (see Pleurisy).