Hemothorax

Description:

Hemothorax (from other - Greek αἷμα — blood and  — a breast) — accumulation of blood in a pleural cavity. Is a consequence of bleeding from vessels of easy, intrathoracic branches of large vessels (an aorta, venas cava), a chest wall, a mediastinum, heart or a diaphragm. Most often a hemothorax arises after an injury of a thorax or as a treatment complication.

Hemothorax symptoms:

The clinic depends on intensity of internal bleeding, a prelum or shift of lungs and a mediastinum. Radical and deep ruptures of a lung are followed by massive bleeding, superficial damages – insignificant. A small hemothorax to 200 ml. in most cases clinically it is not distinguished. The symptomatology comes down to pains in the field of damage and to some restriction of respiratory movements. Further usually resolves with formation of pleural unions. At an average hemothorax cough, short wind, stethalgias, pallor, lag in the act of breath of a thorax from the struck party, weakening of breath and a dullness are noted. Radiodiagnosis reveals blackout at the level of a shovel corner, sometimes with horizontal level. In hard cases into the forefront symptoms of massive intrapleural bleeding act: weakness, pallor of integuments and mucous, tachycardia, short wind, falling of arterial pressure That shades a picture of the main damage. The concern, stethalgias is noted, skin cyanosis, protrusion of intercostal spaces, cough, sometimes with blood, breath difficulty, a dullness, noticeable lag in the act of breath of a thorax, is perkutorno defined a stupid sound, breath is not listened. Degree of anemia depends on blood loss size. The breasts which were injured with wounds even without objective signs of the getting nature of wound look round in a sitting position and have to be hospitalized.

Hemothorax reasons:

On an etiology the hemothorax happens:
  1. traumatic (at the getting wounds or the closed thorax injury);
  2. pathological (consequence of various diseases);
  3. iatrogenic (complication of operations, pleurocenteses, catheterizations of the central veins, etc.).

Treatment of the Hemothorax:

Treatment. Victims with a hemothorax have to go immediately to a hospital for performance of a pleurocentesis. The puncture of a pleural cavity at a hemothorax is made in 6-7 mezhreberye between average and zadnepodmyshechny lines (in a sitting position) or is closer to the back axillary line (in a prone position) at strict observance of rules of an asepsis. Blood from a pleural cavity completely is removed and antibiotics of a broad spectrum of activity are entered. Great opportunities for modern multi-profile medical institutions predetermine use of accurate diagnostic and tactical programs. The solution of questions of the choice of tactics depends on specific conditions of rendering the qualified help. General treatment: haemo static, dezagregantny, immunocorrective, symptomatic therapy, the general and local antibioticotherapia for prevention and treatment of infection, administration of fibrinolitic drugs for prevention and treatment of the curtailed hemothorax.

The indication to surgical treatment – the proceeding bleeding, repeated accumulation of blood after aspiration, release of blood through a drainage of more than 500 ml in 2-3 hours, the curtailed big hemothorax interfering a lung raspravleniya, injury of vitals. It is more preferable to begin with videotorakoskopichesky interventions as to a safe diagnostic method and treatments at a thoracic injury. Indications to a torakoskopiya: the lung wound complicated haemo - and pheumothorax, suspicion of wound of a pericardium, heart, vessels of a chest wall, and also thoracoabdominal wounds. At low localizations of wounds of a breast at the left for the purpose of identification of a condition of a diaphragm obligatory use of a torakoskopiya is recommended.

Indications to a thoracotomy are: heart wound, suspicion of wound of heart or a large vessel, injury of large bronchial tubes or a gullet, the proceeding intrapleural bleeding, a tension pneumothorax, not removable punctures and drainage, wound of a chest lymphatic channel, foreign bodys of a pleural cavity. The diagnosis of the curtailed hemothorax is established thanks to clinic (short wind, pain, fever) and a typical X-ray pattern (existence of homogeneous and intensive blackout on the party of damage of lower parts of the pulmonary field or not homogeneous blackout with liquid levels). The thoracotomy and removal of the curtailed hemothorax executed in the first 5 days prevent development of an empyema of a pleura, promote the most adequate recovery of functional capacities of lungs.