How to Cite This Chapter: Wongkarnjana A, Hambly N, Sładek K, Jankowski M. Hemothorax. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.3.17.3 Accessed November 27, 2020.
Last Updated: August 9, 2019
Last Reviewed: September 8, 2019
Chapter Information

Also see Pleural Effusion.


Hemothorax is the presence of blood in the pleural space due to injury (including thoracic surgery) when the hematocrit of the pleural fluid is ≥50% of the peripheral blood hematocrit. The hematocrit value is used to distinguish hemothorax from a bloody exudate, which is most frequently caused by malignancy or pulmonary infarction (these are associated with a low hematocrit).

Symptoms are the same as in the case of pleural effusion and sometimes may be accompanied by manifestations of blood loss (anemia, tachycardia, hypotension). Complications include bacterial infection, pleural empyema, and fibrothorax.


Urgent pleural drainage. Indications for videothoracoscopy or thoracotomy include ineffective drainage, persistent bleeding (blood loss >400 mL/h for 2-3 hours or 200-300 mL/h for 6 hours), suspected cardiac tamponade, damage to major vessels, necrotic lesions in the pleura, chest wounds, and large air leak from chest tube drainage. The prompt removal of blood from the pleural space reduces the risk of fibrothorax.

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