Distinguishing Between a Hemothorax and a Pneumothorax

In the fall of 1993, my uncle Blue was in a serious motorcycle accident. He had been working on his motorcycle early one afternoon. When he decided to go for a test drive, his back tire came undone from his motorcycle as he was rounding a curve. He immediately lost control of his bike and slid and rolled along the road, finally landing in the soft grass. I am so thankful that there were no cars or trucks traveling closely behind him on the busy highway. Luckily, a car was approaching from the opposite direction and stopped to help. 911 was called and he was immediately rushed to the closest emergency room.

He was diagnosed with road rash, broken ribs, and a left punctured lung that resulted in a hemothorax and a hemopneumothorax. He was connected to two chest tubes as he spent several days in the ICU before being moved to another unit to recover and eventually begin physical therapy. My uncle was in the hospital for a month before he was released home. Even after his release he had a long way to recovery. Because he was still recovering from a punctured left lung, he had difficulty walking long distances and could not be around anyone that smoked.

A few months later and many physical therapy sessions later, my uncle Blue made a full recovery and was back on his new motorcycle riding once again.

To understand more about a hemothorax and a pneumothorax read the information below.

Hemothorax

A hemothorax is a collection of blood in the space between the chest wall and the lung (the pleural cavity).

Causes

● Blunt trauma
● A blood clotting defect
● Open heart surgery
● Pulmonary infarction
● Lung cancer
● Tuberculosis (TB)

Symptoms

● Anxiety caused by increased chest pain
● Increased heart rate
● Rapid, shallow breathing
● Shortness of breath
● Diminished or absent breath sounds from the affected lung
● Low blood pressure due to shock
● Pale, cool, clammy skin

Diagnostics

● Chest X-ray
● CT scan
● A possible thoracentesis (to drain pleural fluid with a needle)

Treatment

Treatment includes:

● Treating the underlying causes for a collapsed lung.
● Stabilizing the patient.
● Stopping the bleeding
● Removing blood from the pleural space by inserting a chest tube through the chest wall between the ribs.

o The chest tube will be left in place until the lung has re-expanded. If bleeding does not stop, surgery (thoracotomy) may be needed to stop the bleeding.

Prognosis depends on the seriousness of the trauma that caused the hemothorax, amount of blood loss, and the stabilization of the patient.