Hémothorax

Physiopathology

The hémothorax comes from an accumulation of Sang in the pleural cavity . Its cause is mainly traumatic, resulting from a or not penetrating penetrating wound, which will involve the rupture of one of the séreuses membranes which recover the Thorax and protect the Poumon S. This rupture makes it possible blood to flow in pleural space, by cancelling the difference in pressure which exists between him and the lungs.
La heavy bleeding can be massive at certain casualties, since each side of the thorax can contain up to 30 to 40% of the volume of blood of an individual.

In the absence of treatment, accumulated blood can make pressure on the Médiastin and the Trachée, and limit the diastolic filling seriously ventricular and deviate the trachea towards the healthy side.

Etiology

The hemorrhage met in the hémothorax comes from various lesions:

lesion of the pulmonary Parenchyma ,
vascular lesion of the pedicle intercostal,
lesion of the Aorta: top priority and reserved forecast.

These lesions are generally traumatic by Plaie S penetrating (Knife, wound by ball, lesion Iatrogène…). They can also occur in certain lung diseases infectious (Tuberculose…) or neoplasic.

Diagnosis

Clinical picture

The most frequent signs and symptoms at the time of a hémothorax are:

a Dyspnea, i.e. breathing difficulties, acute or of progressive aggravation,
a thoracic Pain,
with the pulmonary Sounding, a reduction or an abolition of the murmur vésiculaire (respiratory noise) on the side reached,
with the percussion of the rib cage, a frank, sloping matity with higher limit,
with palpation, an absence of vocal vibration,
of the signs of bad hemodynamic tolerance signing an internal bleeding will have to be systematically required: Tachycardia, Hypotension, Cyanosite, Sweat S, paleness…

Radiograph

A Radiography of the lungs, face and profile, makes it possible to make the diagnosis while making it possible to visualize the épanchement pleural one.

It shows a basal opacity in tablecloth erasing the diaphragmatic cupola and the costo-diaphragmatic bottoms of bag.
Quand épanchement is very abundant, opacity recovers all the hémithorax, drives back the Médiastin opposite side.
Quand it is not very abundant, opacity is limited to a filling of the bottom of lower pleural bag.

Treatment

The objectives of the treatment are to restore a correct oxygenation and a good volemy.

The assumption of responsibility of a hémothorax passes by a treatment etiologic (to look after the cause of the bleeding) and by a drainage of épanchement blood.

The thoracic drainage can be posed on 4th or the 5th space intercostal on the average line axillaire, which involves a minimal repercussion on ventilation. Another possible way is the 2 or the 3rd space intercostal on the line médio-claviculaire.

In the event of hémothorax by rupture of the Aorta, after a thoracic traumatism violate, the immediate recourse to a surgeon thoracic and vascular is essential.

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