Definition
The hematothorax describes an accumulation of blood in the patient’s chest cavity. It represents a special form of pleural effusion. Pleural effusion is an accumulation of fluid between the lung pleura and the pleura, the two so-called pleural leaves.
Together they form the pleura. This effusion can have various causes and different compositions. A hematothorax exists when the fluid of the pleural effusion contains at least half as many solid blood components as the blood. Often a hematothorax occurs in combination with a pneumothorax, which is an accumulation of air in the pleural space and is usually caused by an injury to the lung.
Causes
An accident or the like can lead to external violence/force being exerted on the chest. Vessels of the thorax can be injured. If these vessels are close to the pleura or if they have been additionally injured, blood can quickly flow into the chest cavity.
In rare cases, the vessels can also suffer spontaneous injuries/tears, which also result in bleeding. There can be various reasons for this. Long-standing high blood pressure, arteriosclerosis and medication-based blood thinning can promote such spontaneous ruptures of a vessel.
In addition to vascular injury, organs can also be damaged, resulting in a hematothorax. This can affect all organs located within the thorax. Especially injuries to the mediastinum, a delimited area in the middle of the thoracic cavity, can cause a hematothorax.
The mediastinum contains the thymus (“sweetbread”), the trachea, the esophagus and some lymph nodes. The thymus recedes in adolescence, but can be injured in children, for example, in bicycle falls and handlebar injuries. In addition to the traumatic causes, a hematothorax can also be triggered by a medical procedure.
This includes the placement of a central venous catheter (CVC) in the jugular vein or a drainage as well as the puncture of the pleura, which is performed for diagnostic or therapeutic reasons. Since the attending physician proceeds according to a standardized scheme, it is possible that in individual cases the vessels of a patient run differently than normal and therefore a puncture of the vessels occurs. The attending physician may also place the drainage or puncture needle incorrectly, resulting in a hematothorax.
Thoracotomy” is a surgical procedure in which the chest cavity is opened. This makes it possible to operate on the lungs, heart or organs located within the mediastinum. Since a surgical intervention is not possible without bleeding, at the end of the operation, drains are placed in the thorax and the affected area to drain off the excess blood. If these drains are not sufficient, blood may also accumulate in the thorax and cause a hematothorax.
