Hemothorax usually results from either blunt or penetrating chest trauma. Less commonly, it occurs because of thoracic surgery, pulmonary infarction, neoplasm, dissecting thoracic aneurysm, or anticoagulant therapy.

Hemothorax may result in mediastinal shift, ventilatory compromise, lung collapse and, without successful intervention, cardiopulmonary arrest.

The patient history typically reflects recent trauma. In addition, the patient may complain of chest pain and sudden difficulty breathing, which may be mild to severe, depending on the amount of blood in the pleural cavity.

Inspection typically discloses a patient with tachypnea, dusky skin color, diaphoresis, and hemoptysis (bloody, frothy sputum). If hemothorax progresses to respiratory failure, the patient may show restlessness, anxiety, cyanosis, and stupor. As the chest rises and falls, you may notice that the affected side may expand and stiffen; the unaffected side may rise with the patient’s gasping respirations.

Percussion may disclose dullness over the affected side of the chest; auscultation may detect decreased or absent breath sounds over the affected side, tachycardia, and hypotension.

In hemothorax, treatment aims to stabilize the patient’s condition, stop the bleeding, evacuate blood from the pleural cavity, and reexpand the affected lung. Mild hemothorax usually clears in 10 to 14 days, requiring only observation for further bleeding. In severe hemothorax, treatment includes thoracentesis to remove blood and other fluids from the pleural cavity and then insertion of a chest tube into the sixth intercostal space in the posterior axillary line. The diameter of a typical chest tube is large to prevent clots from blocking it. Suction may also be used. If the chest tube isn’t effective, the surgeon may need to perform a thoracotomy to evacuate blood and clots and control bleeding.