血胸　

WordNet

accumulation of blood in the pleural cavity (the space between the lungs and the walls of the chest) (同)haemothorax

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/13 11:33:57」(JST)

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Hemothorax in an animal

A hemothorax (or haemothorax) is a condition that results from blood accumulating in the pleural cavity.

Cause and presentation[edit]

Its cause is usually traumatic, from a blunt or penetrating injury to the thorax, resulting in a rupture of the serous membrane either lining the thorax or covering the lungs. This rupture allows blood to spill into the pleural space, equalizing the pressures between it and the lungs. Blood loss may be massive in people with these conditions, as each side of the thorax can hold 30 to 40% of a person's blood volume. Even minor injury to the chest wall can lead to significant hemothorax.^[1]

Prognosis[edit]

If left untreated, the condition can progress to a point where the blood accumulation begins to put pressure on the mediastinum and the trachea, effectively limiting the amount that the heart's ventricles are able to fill. The condition can cause the trachea to deviate, or move, toward the unaffected side.

Signs and symptoms[edit]

Tachypnea
Dyspnea
Cyanosis
Decreased or absent breath sounds on affected side
Tracheal deviation to unaffected side
Dull resonance on percussion
Unequal chest rise
Tachycardia
Hypotension
Pale, cool, clammy skin
Possibly subcutaneous emphysema
Narrowing pulse pressure

Management[edit]

A hemothorax is managed by removing the source of bleeding and by draining the blood already in the thoracic cavity. Blood in the cavity can be removed by inserting a drain (chest tube) in a procedure called a tube thoracostomy. Usually the lung will expand and the bleeding will stop after a chest tube is inserted. The blood in the chest can thicken as the clotting cascade is activated when the blood leaves the blood vessels and is activated by the pleural surface, injured lung or chest wall, or contact with the chest tube. As the blood thickens, it can clot in the pleural space (leading to a retained hemothorax) or within the chest tube, leading to chest tube clogging or occlusion. Chest tube clogging or occlusion can lead to worse outcomes as it prevents adequate drainage of the pleural space, contributing to the problem of retained hemothorax. In this case, patients can be hypoxic, short of breath, or in some cases, the retained hemothorax can become infected (empyema). Therefore adequately functioning chest tubes are essential in the setting of a hemothorax treated with a chest tube. To attempt to minimize the potential for clogging, the surgeons will often place more than one tube, or large diameter tubes. Maintaining an adequately functioning chest tube is an active process, usually for the nurses, that often requires tapping the tubes, milking the tubes, or stripping the tubes to minimize potential for clogging in the tube in the setting of a hemothorax. When these efforts fail a new chest tube must be placed, or the patient must be taken to the operating room by a surgeon to open the chest and remove the blood clot, and re insert adequately functioning chest tubes.

Thrombolytic agents have been used to break up clot in tubes or when the clot becomes organized in the pleural space, however this is risky as it can lead to increased bleeding and the need for reoperation.^[2] Therefore, ideally, the tubes maintain their function so that the blood cannot clot in the chest or the tube.

In some cases bleeding continues and surgery is necessary to stop the source of bleeding. For example, if the cause is rupture of the aorta in high energy trauma, intervention by a thoracic surgeon is mandatory.

References[edit]

^ Misthos, P; Kakaris S, Sepsas E et al. (May 2004). "A prospective analysis of occult pneumothorax, delayed pneumothorax and delayed hemothorax after minor blunt thoracic trauma". European Journal of Cardio-thoracic Surgery 25 (5): 859–864. doi:10.1016/j.ejcts.2004.01.044. PMID 15082295.
^ Frye MD, Jarratt M, Sahn SA (May 1994). "Acute hypoxemic respiratory failure following intrapleural thrombolytic therapy for hemothorax". Chest 105 (5): 1595–6. doi:10.1378/chest.105.5.1595. PMID 8181368.

UpToDate Contents

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1. 成人における鈍的胸部外傷の初期評価およびマネージメント initial evaluation and management of blunt thoracic trauma in adults
2. 成人における胸水の診断的評価：初期検査 diagnostic evaluation of a pleural effusion in adults initial testing
3. 胸腔ドレーンの留置およびマネージメント placement and management of thoracostomy tubes
4. 成人における胸壁外傷の初期評価およびマネージメント initial evaluation and management of chest wall trauma in adults
5. 外傷性肋骨骨折の入院マネージメント inpatient management of traumatic rib fractures

English Journal

Endovascular and thoracoscopic treatment for post-lobectomy hemothorax.

Grossi W, Maniscalco P, Quarantotto F, Cavallesco G.SourceDepartment of General and Thoracic Surgery, Sant'Anna Hospital Ferrara, Ferrara, Italy.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.Eur J Cardiothorac Surg.2011 Sep 6. [Epub ahead of print]
PMID 21903411

Innominate truncal dissection and rupture into right pleural cavity following acute type A dissection of the aorta with right coronary ostial avulsion and inferior STEMI.

Kaul P, George R, Paniagua R, Petsa A, Congiu S.SourceDepartment of Cardiac Surgery, Yorkshire Heart Centre, Leeds General Infirmary, Leeds, UK.
Perfusion.Perfusion.2011 Sep;26(5):435-40. Epub 2011 May 12.
An innominate truncal dissection and rupture into the right pleural cavity with massive hemothorax is the initial presentation in this 66-year-old lady with type A dissection of the aorta complicated by right coronary ostial avulsion and inferior STEMI. She underwent supracoronary interposition graf
PMID 21565976

Japanese Journal

IS-29 Mixed Placental Site Trophoblastic Tumor and Epithelioid Trophoblastic Tumor in A Woman Presented with Multiple Lung Metastases, Hemothorax and Intraperitoneal Hemorrhage? : A Case Report(Group4 Oncology4,International Session)