Haemothorax
Overview
Haemothorax is accumulation of blood in the pleural space, most commonly from blunt or penetrating chest trauma but also from iatrogenic causes. In the emergency setting it may cause combined respiratory compromise and haemorrhagic shock.
Immediate priorities are ABCDE‑led resuscitation, rapid identification of intrathoracic bleeding, prompt pleural decompression in the unstable patient and early surgical escalation when bleeding continues or major intrathoracic injury is suspected (Resuscitation Council UK).
Pathophysiology Blood in the pleural cavity produces multiple derangements that commonly coexist and drive rapid deterioration:
- Hypovolaemia and reduced oxygen delivery from intrathoracic haemorrhage.
- Loss of ventilated lung surface as the hemithorax fills, producing hypoxaemia.
- Compression of mediastinal structures and reduced venous return; very large collections may cause tamponade‑like effects on the heart and great veins.
Clinical presentation
- Mechanism: penetrating chest wound, high‑energy blunt trauma, rib fractures, recent thoracic procedures.
- Symptoms: pleuritic chest pain, dyspnoea, cough, haemoptysis; syncope or light‑headedness from blood loss.
- Signs: tachypnoea, reduced chest expansion and breath sounds on the affected side, dullness to percussion (when upright), tachycardia and hypotension if hypovolaemic.
- Tracheal deviation is not typical unless tension physiology is present.