Symptoms
The symptoms vary depending on the extent of fluid accumulation. If there is heavy bleeding into the pleural gap, breathing difficulties occur because the lungs are no longer able to expand properly due to the spatial restriction caused by the accumulation of blood. As a consequence of the impaired breathing, an oxygen deficiency occurs.
The consequences of the lack of oxygen are a blue discoloration of the skin ( cyanosis ), dizziness, fainting and muscle weakness. In addition to the lack of oxygen, a lack of blood in the body’s circulation occurs especially in the case of heavy bleeding. Due to the loss of blood, the human body reacts with a counter-regulation.
The blood pressure drops due to the reduced blood volume, whereas the pulse rate rises significantly. In addition, there is a so-called centralization of the blood. This means that the body channels more blood through the vessels near the heart and the distant limbs such as fingers and toes are less supplied with blood.
This maintains the heart‘s action. Urine excretion is also regulated down by the body in order to save as much fluid as possible. However, if the blood loss is too great, a state of shock can develop.
Diagnosis
The X-ray image shows extensive shading in the presence of a hematothorax. Depending on the extent of the injury, this may occur either immediately after the trauma or over the next few hours. In addition to the hematothorax, an accompanying pneumothorax (accumulation of air in the thorax) can also be seen in the X-ray image.
In addition, the examiner should pay attention to injuries to the spine and ribs.A diagnosis can be made quickly and inexpensively by means of an X-ray image, but a disadvantage is the radiation exposure caused by the X-ray machine and the fact that fluid accumulation can only be detected from about 200ml. The ultrasound examination is particularly good at detecting small fluid accumulations from 50ml upwards. This simple and inexpensive procedure is particularly suitable for monitoring the progress of a hematothorax, as it can be performed while the patient is lying down and simply in the patient’s bed.
The ultrasound examination allows complications to be detected and treated quickly and easily. However, it is not possible to produce an accurate image of air-conducting structures and of the lung by means of ultrasound examination, as air-containing spaces are difficult to visualize. Accompanying injuries of these organs can possibly be overlooked.
A CT scan is also a diagnostic option if a hematothorax is suspected. Computer tomographic imaging is the most accurate and detailed examination method. It can detect air and fluid accumulations in the chest cavity as well as injuries to neighboring organs. Through sectional imaging, the bony structures can also be easily recognized and one or more fractures of the ribs, the sternum or the spine can be additionally excluded. The CT examination allows a quick and non-invasive diagnosis, but the device has the disadvantage of a high radiation exposure (about 1000 times higher than with normal X-rays).
