HAEMOTHORAX

This occurs when blood collects in the pleural space. Haemothorax may vary in amount from small to massive collections.

Causes

  • Trauma
  • Post surgical bleeding
  • Tumours of the chest cavity
  • Chest wall.

Clinical Features

  • Depending on the magnitude of the blood collection, there could be hypovolaemic for massive bleeding, or symptoms similar to those associated with pneumothorax, except for the percussion note, which is dull for haemothorax.
  • However, haemopneumothorax is the more common presentation following chest trauma.

Investigation

  • Chest radiograph.
    • Erect posteroanterior view and lateral
    • Look for fractured ribs, collapsed lung(s), fluid collection in the pleural space (airfluid level), position of mediasternum, and diaphragm.
  • Specialized tests as needed.
  • Other tests relevant to primary underlying cause of the haemothorax.

Management

  • Resuscitation if needed
  • Small haemothorax (blunting of the costophrenic angle), will resolve spontaneously. Conservative management with daily reviews.
  • Large haemothorax will require underwater seal drainage.
  • Physiotherapy as needed.
  • For large clotted haemothorax, perform thoracotomy to drain clot or refer to a more specialized unit.
  • Look at the primary problem
    • For a fracture of rib, inject 2% lidocaine about 2–5ml intercostal block.
    • Advanced malignant disease, coagulopathy, etc., will need to be appropriately managed.