Hemothorax

Introduction The pleural cavity accumulates blood called hemothorax, and the hemothorax caused by penetrating injury such as chest sharpness injury, gunshot wound, or blunt chest injury such as rib fracture is called traumatic hemothorax. A chestnut (original) spontaneous hemothorax secondary to chest or systemic disease or iatrogenic coagulopathy or unexplained cause, also known as non-traumatic hemothorax. The blood chest is often called the pneumothorax at the same time as the pneumothorax. Hemothorax is common in chest trauma patients. Bleeding can occur from intercostal vessels, intrathoracic vessels, pulmonary lacerations, or major and intravascular chest trauma. The number of hemothorax depends on the size of the vascular rupture, the level of blood pressure and the duration of bleeding. Most of the lung tissue hemorrhage is caused by the rupture of the ribs and the lungs.

Cause

Causes of hemothorax

The blood chest can have the following sources: 1 lung tissue laceration bleeding. Because the pulmonary artery pressure is low (1/6 to 1/4 of the aorta), the amount of bleeding is small, and more can stop by itself.

2 chest wall vascular rupture (intercostal blood vessels or blood vessels in the thoracic cavity). Bleeding comes from the systemic circulation, the pressure is higher, the amount of bleeding is more, and it is not easy to stop, often requiring surgery to stop bleeding.

3 heart or large blood vessel bleeding (aorta, pulmonary artery, vein, vena cava, etc.). Mostly acute hemorrhage, hemorrhagic shock, if not timely rescue can often be fatal.

The thoracic cavity is a fixed closed body cavity. When the intrathoracic pressure is increased for various reasons, such as pneumothorax or increased blood in the thoracic cavity, non-severe bleeding can often stop by itself. Intrathoracic hemorrhage has two characteristics. On the one hand, the pressure in the thoracic cavity is low, the inhalation is negative pressure, the chest wall and the lungs continue to move with the breathing, causing the thoracic hemorrhage to be difficult to stop and coagulate, especially when the larger blood vessels are damaged. Often manifested as persistent, progressive bleeding, on the other hand, the pressure of the pulmonary circulation is low, the average pulmonary artery pressure is about 2.0kPa (15mmHg). One side of the chest can accumulate 40% of the circulating blood volume.

an examination

Related inspection

Chest CT examination pleural effusion chest radiograph

Hematological examination

1, history of chest trauma (including iatrogenic) spontaneous hemothorax has cough, increased abdominal pressure, weight, fatigue, exercise, sudden change of body position and other incentives. Diagnosis can usually be made with corresponding clinical manifestations and chest X-ray findings. Thoracentesis is used to establish a diagnosis.

2, pleural hemorrhage can cause hypothermia, but if there is signs of purulent infection such as chills and high fever, increased white blood cell count, the puncture should be sent for bacterial smear and culture examination.

3. The blood chest develops to form a fiber chest. If the range is larger, the thoracic collapse of the disease side may occur, the respiratory movement is weakened, the trachea and mediastinum are displaced to the disease side, and the lung ventilation is reduced. X-ray inspection shows the dense shadows caused by the fiberboard.

Differential diagnosis

Differential diagnosis of symptoms that are easily confused by blood chest

1, pneumothorax

(1) closed (simple) pneumothorax

In the case of expiratory lung retraction, or due to the presence of serous exudate, the visceral pleural rupture is closed by itself, and no air leaks into the pleural cavity. The pressure measurement in the pleural cavity shows that the pressure is increased. After the pumping, the pressure drops without rising, indicating that the break is no longer leaking. The residual gas in the pleural cavity will be absorbed by itself, the pressure in the pleural cavity can maintain the negative pressure, and the lungs will gradually re-expand.

(2) Tension (high pressure) pneumothorax

The pleural rupture forms a flap, which opens when inhaling, and the air leaks into the pleural cavity; when exhaled, the gas in the pleural cavity can no longer be returned to the respiratory tract through the breach and excreted. As a result, the more gas in the pleural cavity accumulates, the high pressure is formed, the lungs are compressed, the breathing is difficult, the mediastinum is pushed to the healthy side, and the circulation is also obstructed, requiring emergency venting to relieve symptoms. If the pressure in the affected pleural cavity rises, after pumping to negative pressure, and then return to positive pressure, a continuous pleural venting device should be installed. Tension pneumothorax is suddenly elevated in the thoracic cavity, the lungs are compressed, the mediastinum is displaced, and there are severe respiratory and circulatory disorders. The patient's expression is tense, chest tightness, and even arrhythmia, often struggling to sit up, irritability, sputum, cold sweat, fast pulse , collapse, and even respiratory failure, unconsciousness.

(3) Traffic (open) pneumothorax

Because of the adhesion and pulling between the two layers of pleura, the breach continues to open, and when inhaling and exhaling, the air freely enters and exits the pleural cavity. The pressure in the affected side of the pleural cavity was 0 up and down, and after several hours of pumping, the pressure did not decrease. Patients often have predisposing factors such as holding heavy objects, holding their breath, strenuous exercise, etc., but there are also those who have pneumothorax during sleep. The patient has a chest pain, shortness of breath, and suffocation on one side, but may have cough, but less, and a small amount of closed pneumothorax has an urgent need. However, after a few hours, it gradually stabilizes, and the X-ray does not necessarily show lung compression. If the amount of gas is large or if there is extensive lung disease, the patient often cannot lie flat. If lying on the side, the pneumothorax is forced to the upper side to relieve the urgency. The degree of dyspnea in patients is related to the amount of gas accumulation and the extent of lesions in the original lung. When there is pleural adhesions and impaired lung function, even a small amount of localized pneumothorax may have obvious chest pain and shortness of breath.

2, blood pneumothorax

Blood pneumothorax is a serious disease in spontaneous pneumothorax. The disease is more dangerous. Most patients have obvious causes of onset, such as strenuous activities and excessive weight bearing. Most of the causes of hemothorax are sudden tears caused by the adhesion between the two layers of the pleura in the chest wall, a small number due to tumor invasion and rupture of giant lung vesicles. Because the disease has both lung compression and bleeding, the symptoms are heavier. The patient has respiratory symptoms such as shortness of breath and chest tightness, as well as circulatory symptoms such as palpitations and shock. The severity of the patient's symptoms is related to lung compression and bleeding.

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