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Last Updated: Aug 29, 2023

Chest Injuries And Hemothorax - Know How Serious It Can Be!

Dr. Mohd Zeeshan HakimGeneral Surgeon • 11 Years Exp.MBBS, MS - General Surgery, MCh (CTVS)
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Hemothorax is a serious and possibly a life-threatening condition in which blood collects between the lungs and the chest wall due to a traumatic injury or some other factor. It can be caused due to an extrapleural or an intrapleural injury. An extrapleural injury damages the chest wall on the outside while an intrapleural injury damages the chest wall on the inside.
Sometimes, Hemothorax is accompanied by excess air in the pleural cavity, known as pneumothorax. If they both occur at the same time, the condition is said to be hemopneumothorax. When blood accumulation is as large as nearly one liter, it has the potential to lead to shock and is referred to as Massive Hemothorax, which can be fatal.

Hemothorax can be caused by a number of factors discussed as follows:

● Traumatic injury in an accident or sports causes the pleural lining of the lungs or chest to rupture. It causes blood to spill over into the pleural cavity, and it finds no way to drain itself out. Chest and lungs are so sensitive that even the smallest of injuries (or seemingly small) have the potential to cause Hemothorax.
Tuberculosis and other lung infections can cause Hemothorax.
Pulmonary embolism refers to a blood clot in the lungs that can cause Hemothorax.
● Lung or pleural cancer also have the potential to cause grave disease.
● Defective blood clotting as in hemophilia in which blood lacks clotting factors can cause Hemothorax.
● Tissue necrosis in the lungs or pulmonary infarction is a lung tissue dysfunction which can cause Hemothorax.
● Tearing of pulmonary blood vessels due to an invasive surgical procedure also has the potential of causing Hemothorax.
● Patients who have undergone major surgeries like lung transplant and open- heart surgery are very likely to get Hemothorax.

There are many symptoms associated with Hemothorax like low blood pressure, rapid rate of heart, cold and pale skin color, chest pain while breathing, tense and shallow
breathing, difficulty in breathing, anxiety, and restlessness.

● Physical examination includes listening to the sounds of abnormal breathing and to the sounds of liquid in the chest.
● An X-Ray image reveals the presence of liquid in the pleural cavity.
● A full Computed Tomography Scan can reveal the occurrence as well as the cause of Hemothorax.
● An ultrasound provides good insight into the situation of the lungs and the pleural cavity.
● Sometimes, a sample of the pleural fluid is extracted for test and diagnosis.

The procedure is performed under anesthesia. A catheter or a needle is inserted into the chest through ribs for removing air and blood from the pleural cavity. If the lung collapses, it is expanded using the chest tube, which is left attached to a closed system. This ensures the escape of air and fluid from the pleural cavity and prevents additional air from entering the pleural space. This section is hence left in a water seal or hooked up to suction.
If the injury is small, chest drainage might be sufficient depending upon the case. However, if there is a major injury, it might require stopping bleeding at its source through a surgery.

Take Away-
Hemothorax can cause a collapsed lung that might progress to lead to respiratory failure. If left untreated, Hemothorax can cause infection in pleura, lung or pleural fluid in the chest cavity. Hemothorax can cause scarring of the lung tissue and pleural membranes. Retained Hemothorax occurs when blood stays in the pleural cavity for too long. It might clot and get difficult to remove through the catheter. It might also cause the buildup of pus in the surrounding region leading to an infection. Retained Hemothorax is treated by draining the fluid differently or through a video-assisted surgical procedure. Before opting for any treatment or surgery, one should always consult a doctor.

In case you have a concern or query you can always consult a specialist & get answers to your questions!

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