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Chest Imaging

Haemothorax

the presence of a significant amount of blood within the pleural space. It most frequently results from trauma, blood entering the pleural space as a consequence of injury to chest wall, diaphragm, lung or mediastinum. A traumatic haemothorax should raise the possibility of an aortic injury. Other causes include pulmonary or pleural malignancy, anticoagulants, bleeding disorders, pulmonary embolism, vascular anomalies such as pulmonary arteriovenous malformation, aortic dissection, pneumothorax, thoracic endometriosis and infection. A haemothorax may also be iatrogenic (after thoracic surgery, central line insertion or percutaneous lung or pleural biopsy).

Bleeding into the pleural space from the lung usually stops spontaneously as it is at low pressure and the source of bleeding is tamponaded by the pleural fluid which compresses and collapses the lung. High-pressure bleeding from systemic vessels results in rapid accumulation of pleural fluid and may form a tension haemothorax.

On the chest radiograph, a haemothorax cannot be distinguished from other pleural fluid collections. A CT scan may show areas of increased attenuation and on ultrasound blood may appear hyperechoic. Immediate tube drainage of a haemothorax should be performed. If not, the fluid loculates and organizes, causing pleural thickening (fibrothorax) which may require decortication.

CF - HM