Hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

The most common cause of hemothorax is chest trauma. It can also occur in patients who have:

• A defect of blood clotting
• Blunt trauma to the chest
• Death of lung tissue (pulmonary infarction)
• Lung or pleural cancer
• Penetrating chest trauma (when a weapon such as a knife or bullet cuts the lung)
• Placement of a central venous catheter
• Thoracic or heart surgery
• Tuberculosis

• Anxiety
• Chest pain
• Rapid heart rate
• Restlessness
• Shortness of breath

Your doctor may note decreased or absent breath sounds on the affected side. Signs of hemothorax may be seen on the following tests:

• Chest x-ray
• CT scan
• Pleural fluid analysis
• Thoracentesis

The goal of treatment is to stabilize the patient, stop the bleeding, and remove the blood and air in the pleural space. A chest tube is inserted through the chest wall to drain the blood and air. It is left in place for several days to re-expand the lung.

When a hemothorax is severe and a chest tube alone does not control the bleeding, surgery (thoracotomy) may be needed to stop the bleeding.

The cause of the hemothorax should be also treated. In trauma patients, depending on the severity of the injury, chest tube drainage is often all that is necessary. Surgery is often not required.

The outcome depends on the cause of the hemothorax and how quickly treatment is given.

• Collapsed lung, leading to respiratory failure
• Death
• Fibrosis or scarring of the pleural membranes
• Pneumothorax
• Shock

Call 911 if you have:

• Any serious injury to the chest
• Chest pain or shortness of breath

Go to the emergency room or call the local emergency number (such as 911) if you have:

• Severe chest pain
• Severe difficulty breathing
• Symptoms of hemothorax

Use safety measures (such as seat belts) to avoid injury. Depending on the cause, a hemothorax may not be preventable.

Eckstein M, Henderson S. Thoracic trauma. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006: chap 42.