Thoracentesis (drainage of pleural fluid through a needle or catheter)
The goal of treatment is to get the patient stable, 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 people who have had an injury, chest tube drainage is often all that is needed. Surgery may not be necessary.
WHAT TO EXPECT AT THE EMERGENCY DEPARTMENT
The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The person may receive:
Breathing support, including oxygen and endotracheal intubation (tube through the nose or mouth into the trachea)
Chest tube (tube through the skin and muscles between the ribs into the pleural space (lining of the lungs)) if there is lung collapse
CAT/CT scan (computerized axial tomography or advanced imaging) of the chest and abdomen
EKG (electrocardiogram or heart tracing)
Fluids (intravenous or through the vein)
Medications to treat symptoms
X-rays of chest and abdomen
The outcome depends on the cause of the hemothorax, the amount of blood loss and how quickly treatment is given.
If associated with major trauma, the severity of that condition and the rate of bleeding will determine the outcome. When associated with cancer or other conditions, the prognosis of the underlying illness usually will determine the outcome.
Collapsed lung, leading to respiratory failure (inability to breathe properly, provide the body enough oxygen and remove carbon dioxide)
Light RW, Lee YCG. Pneumothorax, chylothorax, hemothorax, and fibrothorax. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, PA: Elsevier Saunders; 2010:chap 74.
Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.