| Hemothorax is a bleeding into the chest cavity between the lung and internal chest wall (pleural cavity). Hemothorax is classified according to the amount of blood present: minimal, moderate, or massive. Traumatic hemothorax is caused by blunt or penetrating trauma to the chest. In a chest injury, a rib may lacerate lung tissue or an artery, causing blood to collect in the pleural space. Shock in a trauma victim is often related to a large hemothorax. Hemothorax may also be associated with a collapsed lung (pneumothorax). Incidence and Prevalence: Approximately 300,000 cases of traumatic hemothorax are reported annually in the US (Eggerstedt). |
Source: Medical Disability Advisor
| History: The individual or family member will give a history of blunt injury to the chest (such as from an automobile accident) or penetrating wound (such as from a gunshot). In the absence of an obvious wound, the individual may also complain of shortness of breath and moderate to severe chest pain. Physical exam: Most individuals have decreased breath sounds originating from the hemothorax. The physician may also note dulled sounds while tapping over the involved area. The individual may be anxious and restless and have a rapid heartbeat. Tests: Signs of hemothorax may be evident with chest x-ray, removal of fluid through a needle from the pleural cavity (thoracentesis), and visual or microscopic analysis of this fluid (pleural fluid analysis). CT scanning may be complementary to chest x-ray for precisely identifying location of fluid or blood clots. |
Source: Medical Disability Advisor
| The objective of treatment is to stabilize the affected individual's condition, stop the bleeding, remove the blood in the pleural space, and re-inflate the collapsed lung. A chest tube is pushed through a small hole (between two ribs) in the chest wall to drain the blood (thoracostomy). The chest tube is left in place for several days to re-expand the lung.
The cause of the hemothorax must also be treated. Frequently, surgery is performed because of the nature of injury sustained by trauma. Less than 10% of individuals will require surgical opening of the chest cavity (thoracotomy) for the purpose of removing blood clots or repairing muscles, blood vessels, or internal organs (Eggerstedt). |
Source: Medical Disability Advisor
| If the individual has no additional serious wounds or illnesses and received the described therapy, complete recovery is likely. The outcome after surgery for the otherwise healthy individual is excellent. If treatment is unavailable or not started promptly to stop blood leakage, respiratory failure and death likely will result. The outcome is not predictable if the individual sustained serious wounds other than the hemothorax. |
Source: Medical Disability Advisor
| Individuals who suffer from traumatic hemothorax will either require the placement of a chest tube or a thoracotomy. Either of these procedures will necessitate occupational, physical, and respiratory therapy. All therapies will begin in the hospital, with physical therapy and possibly occupational therapy continuing after discharge from the hospital 2 to 3 times a week for 6 weeks.
Respiratory therapy addresses increasing lung capacity and decreasing the risk for the buildup of lung secretions. Respiratory therapists teach individuals pursed lip breathing to increase the airflow to the lungs. Individuals may also use an incentive spirometer, which is a device that measures and displays the amount of air inspired to help motivate individuals to take deeper breaths. Individuals also learn to produce an effective cough. Individuals learn to hold a pillow to the incision area when coughing, laughing, or performing activity such as walking. This technique, called "splinting," can help alleviate pain at the incision site. Individuals learn positions to relieve shortness of breath, and techniques to relieve pain at the incision site.
Occupational therapy addresses any fatigue or shortness of breath that may occur during activities of daily living. Occupational therapists may also teach energy conservation techniques, in which activities of daily living such as meal preparation are broken up into smaller components, thereby making tasks more manageable.
Physical therapy addresses decreased endurance, strength, and range of motion. Because individuals often bend forward to alleviate pain at the site of a chest tube or thoracotomy, they learn to stretch the shoulder and chest muscles to help normalize posture. Individuals perform strengthening exercises of the arms and legs to improve overall endurance, and of the upper back to promote normal posture. Individuals also strengthen the diaphragm by lying on the back and performing abdominal breathing exercises. Individuals may perform aerobic activity such as walking on a treadmill or riding a stationary bicycle to further increase endurance. |
Source: Medical Disability Advisor
| Complications include shock due to massive bleeding from cut blood vessels and organs before surgery, lung abscess (empyema), or fibrous clot within the pleural cavity (fibrothorax). |
Source: Medical Disability Advisor
| When the individual returns to work, recovery from surgery will restrict work to sedentary duties for the otherwise healthy individual for 6 weeks. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Was diagnosis of hemothorax confirmed?
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Was hemothorax diagnosed by x-ray?
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Was fluid removed from the pleural cavity and analyzed for signs of blood?
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Did individual sustain any injuries elsewhere in the body?
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Has individual experienced complications such as shock due to massive bleeding from lacerated blood vessels or organs, empyema, or fibrothorax?
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Does individual have an underlying condition that may impact recovery?
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Has individual been examined for other lung diseases such as lung cancer, or emphysema?
Regarding treatment:
- Was treatment prompt and appropriate?
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Did individual require surgery to remove clotted blood?
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Was surgery required to repair muscle, blood vessels, and/or internal organs?
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Was treatment effective?
Regarding prognosis:
- Did unexpected complications occur?
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Can delayed recovery be explained through other factors?
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Are wounds healing as expected?
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Source: Medical Disability Advisor
| Eggerstedt, Jane M. "Hemothorax." eMedicine. Eds. Jeffrey C. Milliken, et al. 6 Nov. . Medscape. 7 Jan. 2005 <http://emedicine.com/med/topic2915.htm>. |
Source: Medical Disability Advisor