Hemothorax

What is hemothorax?

Hemothorax is a serious condition in which blood collects in your pleural space. Your pleural space is a hollow area (cavity) between your lungs and your rib cage. Without treatment, blood can continue to accumulate and put so much pressure on the outside of your lung that it can’t fully inflate.

If you have symptoms of hemothorax, especially trouble breathing after an injury to your chest, contact a healthcare provider right away.

What happens during hemothorax?

To understand what happens during hemothorax, it helps to understand the function of your pleural space. The pleural space helps control the pressure inside and around your lungs as you breathe. It contains a thin layer of fluid (pleural fluid). Pleural fluid helps the tissue (pleura) that covers your lungs and lines the interior wall of your chest move as you breathe.

A chest injury, trauma, surgery or another condition can cause blood to enter your pleural space and mix with the pleural fluid.

How common is hemothorax?

Hemothorax is common. Experts estimate that there are almost 300,000 cases of hemothorax each year in the U.S.

What are the symptoms of hemothorax?

Common hemothorax symptoms may include:

• Shortness of breath (dyspnea).
• Rapid breathing (hyperventilation).
• Rapid heart rate.
• Chest pain.
• Low blood pressure (hypotension).
• Feelings of restlessness.
• Anxiety.
• Fever.

In some severe cases, hemothorax may cause death.

What causes hemothorax?

A major injury, chest trauma and surgery are the most common causes of hemothorax. Other causes may include:

• A blood clotting disorder.
• Lung cancer.
• Pleural mesothelioma.
• Lung tissue death (pulmonary infarction).
• Thoracic (chest) surgery, including heart surgery.
• Blood vessel damage during central venous catheter placement.
• Ehlers-Danlos syndrome.
• Tuberculosis.

Who does hemothorax affect?

Anyone can develop hemothorax, especially after a chest injury or trauma. Other risk factors include:

• Chest surgery. Any surgeries that involve your lungs or areas near your lungs may cause hemothorax. Examples include open heart surgery or a lung transplant.
• Repetitive chest injuries. Certain sports or activities that have chest injury risks can increase your risk of hemothorax. Examples include football, hockey, weightlifting, boxing, martial arts and wrestling.

What are the complications of hemothorax?

Hemothorax can cause other complications in your body. These may include:

• Difficulty breathing or inability to breathe on your own (respiratory failure).
• Hypovolemic shock.
• Empyema.
• Scarring in your pleural tissue or lung tissue.

How is hemothorax diagnosed?

A healthcare provider can diagnose hemothorax. They’ll conduct a physical examination. They’ll also listen to your lungs with a stethoscope (auscultation). During an auscultation, they’ll listen for abnormal sounds coming from your affected lung. They’ll also order tests to confirm their diagnosis.

What tests will be done to diagnose hemothorax?

Your provider will order imaging tests to help confirm hemothorax. These may include:

• Chest X-ray.
• Computed tomography (CT) scan.
• Thoracentesis.

How do you fix hemothorax?

Healthcare providers treat hemothorax by removing the blood from your pleural space.

They’ll first support your breathing by giving you oxygen therapy or, in severe cases, mechanical ventilation.

Next, depending on the severity of your hemothorax, they’ll either insert a thin needle (thoracentesis) or chest tube (thoracostomy) between your ribs to remove blood from your pleural space. If blood continues to fill your pleural space even with drainage, a surgeon will make an incision (cut) in your chest to access your affected lung and treat the cause (thoracotomy).

You may need a blood transfusion if you lose a lot of blood.

Do all hemothorax need a chest tube?

No, not all hemothorax treatments require a chest tube. Minor hemothorax may only require a thin needle to drain blood from your pleural cavity.

What are the risks of hemothorax treatment?

All hemothorax treatments have risks. These risks may include:

• Anesthesia problems.
• Pain.
• Bleeding.
• Infection, including pneumonia.
• Pulmonary edema.

How soon after hemothorax treatment will I feel better?

Your recovery depends on what caused your hemothorax and the type of treatment. You may need to stay in a hospital for several days if you need a chest tube or surgery. Your healthcare provider will tell you what to expect during your recovery and when you can expect to return to your normal activities, including work or school.

How can I lower my risk of developing hemothorax?

You can’t prevent some hemothorax causes. But you can lower your risk of chest injuries or trauma that could lead to hemothorax by:

• Wear protective padding for activities and sports that increase your risk of chest injury.
• Always wear a seatbelt while in a car.
• Use the proper tools or equipment or ask for help when reaching for items above your head. Don’t stand on stools, chairs or tables.
• Use a cane, walker or crutches if you have difficulty walking or are at a greater risk of falling.

What can I expect if I have hemothorax?

Hemothorax is a serious condition that requires medical attention. You may be in the hospital for a few days or longer. A hospital stay allows providers to ensure you’re healing properly and give you oxygen, if necessary. However, with proper diagnosis and prompt treatment, most people fully recover without any long-term issues.

How do I take care of myself?

As you recover from hemothorax, it’s a good idea to avoid any activities that can damage or put pressure on your lungs, including:

• Smoking.
• Intense workouts, including heavy lifting or bending.
• Contact sports.
• Scuba diving or deep-sea diving.
• Traveling in airplanes.

When should I see my healthcare provider?

See your healthcare provider for any follow-up appointments. They may order imaging tests to make sure you’re healing as expected.

When should I go to the ER?

Get to an emergency room as soon as possible if you have trouble breathing or intense pain in your chest.

What questions should I ask my healthcare provider?

• How do you know I have hemothorax?
• How serious is my hemothorax?
• Is there anything I can do to prevent another hemothorax?
• What treatment do you recommend?
• How long will it take me to recover?
• Will I need extra oxygen?
• Will I need to stay in the hospital?

Is hemothorax life-threatening?

It depends on the severity of your hemothorax and how long it takes the bleeding to stop. Minor hemothorax can heal without any risks or complications. Severe hemothorax can be fatal without prompt treatment.

What’s the difference between hemothorax and pneumothorax?

Hemothorax is when blood pools in your pleural space. Pneumothorax is when air enters your pleural space and presses against your lung, which causes it to partially or fully collapse.

Is hemothorax a collapsed lung?

No, a hemothorax and a collapsed lung are different conditions. Another name for a collapsed lung is pneumothorax.

What’s the difference between hemothorax and pleural effusion?

Pleural effusion is when you have excess pleural fluid in your pleural space. Healthcare experts estimate that the average adult has about 5-10 mL (about 1-2 teaspoons) of pleural fluid on each side of their pleural space.

A note from Cleveland Clinic

Hemothorax is a condition in which you have blood in your pleural space. It usually causes symptoms that affect your chest and breathing. If you have symptoms that affect your chest or your ability to breathe, seek medical care right away. A healthcare provider can diagnose hemothorax, determine its cause and get you the most effective treatment.