Accumulation of blood in the pleural cavity (between lungs and chest wall)

– Usually due to chest injury or trauma
– Bleeding from lung or chest wall blood vessels

Can impair lung function

Large blood volume accumulation or rapid blood loss (massive haemothorax)

– Surgical intervention for life-threatening cases
– Thoracostomy and chest drainage for most cases

– Trauma including:
○ Penetrating chest injury
○ Blunt force trauma to the chest

– Chest surgeries
– Ruptured blood vessels
– Blood clotting disorders
– Rarely spontaneous bleeding

– Participation in contact sports
– Occupations with a higher risk of chest trauma

– Blood clotting disorders (e.g., haemophilia)
– Use of anticoagulant medications

Accumulation of blood in the pleural cavity, the space between the lungs and chest wall

– Compression: Blood accumulation leads to lung compression
– Impaired function: Lung function is impaired due to compression and reduced lung expansion

– Lungs: Bleeding may originate from the lungs
– Major blood vessels: Bleeding from large chest blood vessels
– Chest wall: Bleeding from blood vessels in the chest wall

Blood accumulation can cause lung collapse and result in respiratory distress

Differential diagnosis includes:
– Pneumothorax (accumulation of air in the pleural cavity).
– Pleural effusion (accumulation of fluid in the pleural cavity).
Other causes of chest pain and respiratory distress:
– Pulmonary embolism.
– Cardiac conditions (e.g., myocardial infarction).
– Pneumonia.
– Pleuritis.
– Musculoskeletal chest pain.
– Acute respiratory distress syndrome (ARDS).

Varied incidence: Dependent on factors like trauma rates and population demographics

– More common in younger individuals
– More prevalent in males

– Chest pain: Common symptom.
– Shortness of breath: Difficulty breathing.
– Rapid breathing: Increased respiratory rate.
– Decreased breath sounds: Reduced or absent lung sounds on the affected side.
– Decreased oxygen saturation: Lower levels of oxygen in the blood.
– Signs of shock: Hypotension, rapid heart rate, and altered mental status if significant blood loss has occurred.

Imaging:
– Chest X-ray or CT scan to visualize blood in the pleural cavity, assess the extent, and identify associated injuries
– Ultrasound is preferred in emergency settings for higher sensitivity

Blood tests:
– Assess blood loss, clotting function, and blood type for potential transfusion

Pleural fluid sampling:
– Haemothorax is confirmed if pleural fluid hematocrit is ≥0.5 times that of peripheral blood

Clinical examination: Look for reduced breath sounds, dulled percussion, and haemodynamic instability in patients with chest trauma, pain, and dyspnea

– Address the Underlying Cause: Identify and treat the root cause of the haemothorax.
– Stabilize the Patient: Ensure stability and manage associated injuries.
– Evacuate Blood: Remove blood from the pleural cavity, typically via chest tube insertion.
– Blood Transfusion: Administer if required to maintain hemodynamic stability.
– Surgery: Consider surgical intervention, especially in cases of massive haemothorax to control bleeding or repair blood vessels.

Definition: Massive haemothorax involves significant initial blood drainage or rapid ongoing bleeding.
Primary Survey: Oxygen administration, cautious fluid resuscitation, blood transfusion (1:1 ratio of packed red cells to fresh frozen plasma), and tranexamic acid administration.
Definitive Management: Surgery is often required, with Video-Assisted Thoracoscopic Surgery (VATS) preferred over surgical thoracotomy.

Preventive Measures:
– Prevent clots, empyema, pleural effusion, and fibrothorax.
– Prophylactic antibiotics to prevent or treat empyema.
– Use fibrinolytic therapy cautiously for clot management.

Emergency Focus:
– Primary survey for trauma patients with suspected massive haemothorax.
– Administer oxygen, perform cautious fluid resuscitation, provide blood transfusion, and administer tranexamic acid.
– Surgery is the definitive treatment with a preference for VATS over thoracotomy. Involve a cardiothoracic team as needed.

– Severity of underlying injury
– Extent of blood loss
– Effectiveness of treatment and timely intervention

Most individuals can fully recover with appropriate and effective management.

– Infection (empyema) of pleural cavity
– Persistent bleeding
– Lung damage
– Respiratory distress
– Organ dysfunction due to blood loss or injuries