bubble_chart Overview

Traumatic hemothorax is the accumulation of blood in the pleural cavity caused by chest trauma and is a common complication of chest injuries. 70% of chest trauma cases are accompanied by varying degrees of hemothorax, often coexisting with pneumothorax. Rib fractures, sharp objects, or firearms causing chest injuries can all lead to hemothorax. The bleeding originates from lung injuries, chest wall vascular injuries, or major cardiovascular injuries, with chest wall vascular injuries being the most common cause. However, bleeding from major cardiovascular injuries is often fatal, frequently resulting in death at the scene due to insufficient emergency intervention. Traumatic hemothorax is classified based on the volume of blood in the pleural cavity: - **Small hemothorax** (less than 500 ml): X-ray examination shows only the disappearance of the costophrenic angle. - **Moderate hemothorax** (500–1000 ml): X-ray examination reveals a fluid level reaching the hilum (mid-scapular level). - **Massive hemothorax** (more than 1000 ml): X-ray examination shows a fluid level extending to the upper hilum (above the mid-scapular level).

bubble_chart Clinical Manifestations

1. Small hemothorax: No obvious symptoms or signs.
2. Moderate to large hemothorax:
   1. Manifestations of hemorrhagic shock: Pale complexion, cold and clammy limbs, anemia, rapid and weak pulse, hypotension;
   2. Respiratory manifestations: Chest tightness, chest pain, shortness of breath, cyanosis, hemoptysis;
   3. Intercostal fullness, restricted respiratory movement, tracheal and mediastinal shift to the healthy side, dullness or flatness on percussion of the affected chest, weakened or absent breath sounds. In the case of hemopneumothorax, tympany is heard on percussion of the upper chest, while dullness or flatness is heard on percussion of the lower chest.

bubble_chart Diagnosis

1. History of chest trauma;
2. Moderate or large hemothorax may present with hypovolemic shock symptoms such as decreased blood pressure, rapid and thready pulse, and dyspnea, along with signs of pleural effusion.
3. X-ray examination reveals the affected lung field obscured by fluid shadow, mediastinal shift to the contralateral side, and in cases of hemopneumothorax, a fluid level may be observed.
4. Thoracentesis yields blood.

bubble_chart Treatment Measures

1. Small hemothorax: Closely monitor the condition and administer appropriate antibiotics to prevent infection.
2. Moderate or large hemothorax (non-progressive): Replenish blood volume, administer antibiotics, and perform early closed thoracic drainage to facilitate observation for progressive bleeding, effectively drain accumulated blood in the chest, and promote lung re-expansion. After thoracentesis, inject antibiotics into the chest cavity.
3. Progressive hemothorax: Prepare for blood transfusion, replenish blood volume, promptly perform exploratory thoracotomy to locate the bleeding site, and take corresponding measures. Administer antibiotics to prevent infection.
4. Coagulated hemothorax: Perform thoracotomy within one week after bleeding stops to remove accumulated blood and clots, preventing infection or organization. Administer antibiotics to prevent infection.
5. Organized hemothorax: Perform fibrous membrane stripping 4-6 weeks after injury. Administer antibiotics to prevent infection.
6. Hemothorax complicated by empyema: Treat as empyema, perform closed thoracic drainage as early as possible. Administer systemic antibiotics in sufficient doses.
7. Provide symptomatic and supportive treatment.

The chest wall and intrathoracic organs have abundant blood circulation, and thoracic trauma is often accompanied by intrathoracic bleeding. Penetrating chest injuries invariably involve hemothorax. For traumatic hemothorax, closely monitor the condition. Moderate or larger hemothorax should be treated with closed thoracic drainage as early as possible to facilitate observation for progressive bleeding. Administer blood transfusion and fluid infusion to replenish blood volume and actively treat shock. In the early stages of moderate or larger hemothorax, the decision on whether emergency thoracotomy for hemostasis is needed often arises. Emergency thoracotomy for hemostasis is usually urgent, sometimes performed before the patient's shock is fully corrected. In such cases, active bleeding points may not be found after removing clots or accumulated blood. Wait until blood replenishment or autotransfusion of intrathoracic blood raises blood pressure before thorough examination, often revealing the bleeding site. Rebleeding after thoracotomy for hemothorax is rare, but postoperative monitoring remains essential. The risk of intrathoracic infection is relatively high. Therefore, in addition to administering high-dose antibiotics and ensuring drainage tube patency, encourage and assist the patient in effective coughing to expel pulmonary secretions, promote lung re-expansion, and eliminate residual intrathoracic space to prevent infection.

bubble_chart Cure Criteria

1. Cured: Symptoms and signs disappear; X-ray examination shows the disappearance of intrathoracic effusion and pneumothorax, with lung re-expansion.
2. Improved: Symptoms and signs are alleviated, and other complications have improved.
3. Not cured: Symptoms and signs show no improvement, other complications persist, and X-ray examination reveals the continued presence of intrathoracic fluid and gas.