Hemothorax is usually a complication of a chest injury, though other things can cause the condition as well -- it can even occur spontaneously. A person with hemothorax may feel stress or anxiety and not know why. While the condition can be mild with barely any symptoms, severe cases are medical emergencies. Catching hemothorax early is important for effective intervention. Treatment depends on severity, but anyone experiencing difficulty breathing or chest pain should call 911.
Knowing a little about the anatomy of the lungs helps understand what a hemothorax is and its profound effects on the body. A two-layer membrane covers each lung. The visceral layer surrounds the actual lung tissue, and the parietal layer connects to the chest wall. Between these two layers is a space called the pleural cavity. A hemothorax occurs when blood collects in this space.
The most common cause of hemothorax is blunt force trauma to the chest resulting from a sudden, intense impact. This can result from a car accident or a hard fall. Less common causes include blood clotting defects, lung or pleural cancer, tuberculosis, lung tissue death, or complications of thoracic or cardiac surgery.
Signs of hemothorax include anxiety, restlessness, chest pain, rapid heart rate, rapid shallow breathing, shortness of breath, and pale, cool, and clammy skin. In severe cases, people with hemothorax experience low blood pressure as a result of hypovolemic shock. Anyone experiencing a rapid heart rate and shortness of breath should seek emergency medical attention.
When a doctor suspected mild hemothorax, she will listen to lung sounds as a part of the physical exam. If the doctor notes decreased or absent lung sounds or other signs of distress, she will likely send the patient to the emergency room. Generally, the symptoms of moderate or severe hemothorax are quite dangerous, and the condition is a medical emergency if there is active bleeding.
The most common way to diagnose hemothorax is with a chest x-ray. The accumulation of blood is easily visible, but further testing may be needed. A CT scan can evaluate the extent of the damage. In emergency situations, a thoracentesis will drain the blood using a needle and syringe, and the surgeon may insert chest tubes so the blood can continue to drain. While these actions do not address the cause of the problem, they allow full expansion of the lung.
Because hemothorax is a serious condition that may be life-threatening, treatment progresses quickly. In addition to multiple tests, doctors are likely to put the patient on breathing support. For cases that are not too severe, supplemental oxygen may be enough. In serious cases, the patients may require a breathing tube and ventilator. Fluids will also be given via IV to increase blood volume in the body.
The outcome of hemothorax depends on a few factors. Sometimes the injury causing the bleeding resolves on its own after the doctor has drained the blood and the lung can expand and recover. Some people may require surgery. If the injury is severe and blood rapidly accumulates, the outcome depends on how quickly the person receives treatment and how much blood was lost.
Complications can arise at any time. The person is at risk for empyema, an infection of the pleural space, and other issues depend on the underlying cause. Severe hemothorax can lead to shock and death, especially without immediate treatment. Respiratory failure, collapsed lungs, or pneumothorax can also occur. Once someone has recovered from hemothorax, they could be left with scarring of the pleura or lung tissue.
Hemothorax is dangerous for several reasons. As blood fills the pleural space, it prevents the lung from expanding, causing respiratory distress and even complete collapse if the blood is not removed quickly. A severe hemothorax is a massive internal bleed that depletes the blood volume circulated throughout the body by the heart.
Since blunt force trauma is the main cause of hemothorax, the best prevention is being safe. Wearing a seatbelt is key to preventing injury in the event of a car accident. Contact sports can also lead to chest injuries, so athletes should take care to wear proper safety equipment and see a doctor if they experience symptoms after an impact.
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