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Feller-Kopman DJ, Reddy CB, DeCamp MM, et al. Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Oct 1;198(7):839-849. doi: 10.1164/rccm.201807-1415ST. PubMed PMID: 30272503.
Davies HE, Davies RJ, Davies CW; BTS Pleural Disease Guideline Group. Management of pleural infection in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010 Aug;65 Suppl 2:ii41-53. doi: 10.1136/thx.2010.137000. Review. PubMed PMID: 20696693.
Also see Pleural Effusion.
DefinitionTop
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.
TreatmentTop
Urgent pleural drainage. Large-bore (>16 F) chest tube placement and drainage to evacuate the pleural space are strongly recommended. Indications for videothoracoscopy or thoracotomy include ineffective drainage, persistent bleeding (blood loss >400 mL/h for 2-3 h or 200-300 mL/h for 6 h), 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.
