Hemothorax: Causes, Symptoms, Treatment and Cost

Hemothorax is a medical term for a condition in which there is an accumulation of blood in the pleural space, the area between the lungs and chest wall. The amount of blood can range from a small amount to several litres.

There are two types of hemothorax:

• Traumatic Hemothorax: Traumatic hemothorax occurs when there is an injury to the chest and/or ribs resulting in a tear in one of the blood vessels within the pleural space, allowing blood to accumulate between the layers of tissue.
• Spontaneous Hemothorax: Spontaneous hemothorax occurs when there is no external cause and is usually related to an underlying medical condition such as lung cancer, pulmonary embolism, or thoracic aortic dissection. In some cases, it may be caused by conditions such as pulmonary hypertension or connective tissue disorders that cause abnormal thickening of vessel walls which can lead to rupture.

• Hemothorax can be caused by trauma such as rib or chest wall injuries or medical conditions such as lung cancer, pulmonary embolism, or infection.
• Other causes include surgery, pulmonary hypertension, chest tube insertion, and use of anticoagulant medications.

Common symptoms of hemothorax are:

• Chest pain and tenderness.
• Shortness of breath.
• Rapid heart rate
• Rapid breathing
• Coughing up blood/bloody sputum.
• Low blood pressure (hypotension).
• Fatigue or feeling weak.
• Bluish tint to the skin (cyanosis).

• Avoid any activity that could result in blunt chest trauma, such as contact sports.
• Follow up with your doctor after any chest trauma or surgery in which the chest was opened.
• Maintain a healthy lifestyle by eating nutritious foods and exercising on a regular basis.
• Quit smoking and avoid secondhand smoke exposure if possible.
• Wear a seat belt when driving and motorcycle helmets if riding motorcycles or bicycles.
• Seek medical attention immediately for any signs or symptoms of a hemothorax, such as chest pain, difficulty breathing, coughing up blood, rapid heart rate, or low blood pressure levels.

Diagnosis of a hemothorax usually involves:

• Physical exam: On physical exam, a patient with hemothorax may have decreased breath sounds on the affected side, tenderness to palpation of the chest wall, and a dull percussion note. The patient may also have tachycardia and hypotension if the hemothorax is severe.
• Chest CT scan: A chest CT scan is the most effective way to diagnose a hemothorax. The scan will show any fluid or blood in the pleural space, which can help to identify the presence and size of a hemothorax.
• Complete blood count (CBC): In hemothorax, the CBC may show anaemia (low red blood cell count), decreased platelet count, or an increase in white blood cell count if there is infection present.
• Arterial blood gas analysis: An arterial blood gas analysis is an important diagnostic tool for hemothorax because it provides information about the oxygenation and acid-base balance of the patient's blood. It can help to identify any underlying respiratory or metabolic abnormalities that may be contributing to or causing a hemothorax.
• Echocardiography: Echocardiography is a diagnostic imaging technique used to assess the structure and function of the heart and blood vessels surrounding it. An echocardiogram can detect any changes in the size or shape of the heart, as well as any blockages or structural defects.

• Respiratory failure: Hemothorax can cause difficulty breathing due to the accumulation of fluid in the chest cavity, leading to respiratory failure.
• Infection: If untreated, a hemothorax can cause infection due to the accumulation of blood and fluid in the chest cavity.
• Lung collapse: A hemothorax can cause a lung collapse due to pressure on the lungs from the buildup of blood and fluid in the chest cavity.
• Severe anaemia: A large amount of blood lost from a hemothorax can lead to severe anaemia, which is a decrease in red blood cells needed for oxygen transport throughout the body.
• Air embolism: If air enters into the bloodstream during a hemothorax, it can cause an air embolism which can be life-threatening if not treated promptly.

• Boil 1 teaspoon coriander seeds in a glass of water, strain, and drink twice daily.
• Make a paste by adding some honey to 1 tablespoon of basil leaves (tulsi) and consume it once or twice daily for relief from chest pain caused by hemothorax.
• Consume half to one teaspoon of Amla powder with lukewarm water every morning on an empty stomach for relief from hemothorax symptoms like chest pain, breathing difficulty etc.
• Make a decoction by boiling two teaspoons each of cumin (jeera), fenugreek (methi) seeds and dry ginger (sonth) in two cups of water until it reduces to one cup, strain and drink the decoction once or twice daily for relief from hemothorax symptoms like chest pain etc.
• Prepare juice from bitter gourd (karela), mix some honey in it and consume it once or twice every day for alleviating hemothorax symptoms like difficulty in breathing etc.

• Foods rich in Vitamin C and antioxidants: Fruits such as oranges, lemons, and grapefruits; vegetables such as kale, spinach, and broccoli; nuts such as almonds and walnuts; and legumes like beans, chickpeas, and lentils.
• Complex carbohydrates: Whole grains like brown rice, quinoa, oats, barley; starchy vegetables like sweet potatoes and corn; and whole-grain breads.
• Lean proteins: Fish like salmon; lean cuts of beef or pork; poultry such as chicken or turkey breast; eggs; low-fat dairy products such as yoghurt or milk; legumes like beans or lentils.
• Healthy fats: Avocado, olives, olive oil, nut butter (such as almond butter), nuts (almonds, walnuts), seeds (chia seeds).Plenty of water to stay hydrated.

• Foods high in fat and cholesterol: Eat less red meat, whole-fat dairy products, fried foods, and processed meats.
• High sodium foods: Processed and canned foods, which are high in sodium, should be limited or avoided.
• Sugary drinks and snacks: Reduce intake of sugary beverages like soda, sports drinks, and energy drinks as well as sweet snacks like candy and cookies.
• Alcohol: Avoid drinking alcohol as it can cause fluid buildup in the lungs resulting in pleural effusion.

Treatment for a hemothorax depends on the severity of the condition. Generally, treatment may include:

• Observation: If the hemothorax is small and not causing any symptoms, it may be observed without any treatment.
• Chest tube drainage: A chest tube may be inserted to drain excess blood and air from the pleural space.
• Medications: Medications such as antibiotics and anti-inflammatory drugs may be prescribed to reduce inflammation and prevent infection.
• Blood transfusions: If there is significant blood loss, a blood transfusion may be necessary to replace lost blood volume.
• Video-assisted thoracoscopic surgery (VATS): A small camera is inserted through a tiny incision in the chest wall, allowing the surgeon to see inside the chest cavity and remove any blood clots or other debris.
• Open thoracotomy: A larger incision is made in the chest wall and surgical instruments are used to remove any blood clots, repair fractured ribs, or stop bleeding vessels.
• Surgical ligation: The surgeon can use sutures and clips to control bleeding vessels within the chest cavity.
• Thoracic embolization: An interventional radiologist can insert a catheter into an artery in an arm or leg and guide it up into the chest cavity where a tiny coil is delivered that stops bleeding from a vessel inside the thorax.

The type of doctor that should be consulted for hemothorax depends on what is causing it. Generally, a pulmonologist (lung specialist), cardiothoracic surgeon, or interventional radiologist would be consulted for diagnosis and treatment of this condition. In some cases, an emergency medicine physician may also need to be consulted if there is an acute injury or trauma causing the hemothorax.

• Diuretics: Diuretics are medications that help to reduce the amount of fluid in the body by increasing urine output. Diuretics can help to reduce the amount of fluid in the chest cavity and improve breathing. Examples of diuretics that may be prescribed for hemothorax include furosemide, hydrochlorothiazide, and spironolactone.
• Analgesics: In the case of a hemothorax, analgesics can be used to help relieve any pain caused by the buildup of blood in the chest cavity. Acetaminophen and nonsteroidal anti-inflammatory drugs are common analgesics used for this condition (NSAIDs).
• Blood thinners: Blood thinners, also known as anticoagulants, are medications that prevent blood clots from forming. Blood thinners may be prescribed in the case of a hemothorax to reduce the risk of further bleeding into the chest cavity.
• Corticosteroids: These drugs can help reduce inflammation and swelling in the chest cavity caused by Hemothorax. Examples include prednisone, methylprednisolone, and dexamethasone.

The length of recovery from a hemothorax is determined by the severity of the condition and the treatment received.Recovery time can range from a few days to several weeks or months. Additionally, if surgery is required to treat the hemothorax, it may take longer for full recovery.

The treatment for a hemothorax is determined by the underlying cause. While treatment can often provide relief and help prevent future hemothorax episodes, it is not always permanent, and additional care may be required depending on the underlying cause.

• Monitor vitals and chest radiograph (CXR) regularly to ensure resolution of the hemothorax: Pulse oximetry and CXR should be done every 24 hours for the first few days following treatment, then every 48-72 hours until resolution is seen.
• Keep patient in upright position: Upright positioning is important for re-expansion of the lung and drainage of any fluid that might accumulate in the hemithorax.
• Provide pain relief as needed: Depending on the severity of the pain, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, or local anaesthetics can be used to manage it.
• Maintain adequate hydration and nutrition: Adequate hydration helps to prevent fluid from accumulating in the hemithorax, while nutrition helps to maintain energy levels during recovery from a hemothorax.
• Perform regular dressing changes as advised by a doctor: Dressings should be changed regularly to remove any accumulated fluid or blood clots and reduce risk of infection.
• Administer antibiotics as prescribed by a doctor: Antibiotics may be prescribed if there is suspicion of infection or if there is evidence of infection on imaging studies or laboratory tests.

The cost of Hemothorax treatments in India can vary depending on the severity of the condition and the type of treatment required.

Generally, treatments can range from a few hundred rupees to several thousand rupees. Treatment costs may include hospital and doctor fees, diagnostic tests, medications, surgical procedures, and any other related costs.

Common side effects of hemothorax treatments include pain, discomfort, fever, and nausea.

Other potential side effects may include infection, inflammation, fluid accumulation in the pleural cavity (pleural effusion), and respiratory distress.

Rarely, hemothorax treatments can cause serious complications such as blood clots in the lung or severe lung damage due to scarring or infection.

If you are suffering from any complications relating to Hemothorax then you should consult a doctor nearby as they can cause complications like respiratory failure, infection, lung collapse, etc. in which treatment course can range from a few months to years depending on the severity of the situation.