A pleural hematoma is a collection of blood in the pleural cavity. This is a condition that can cause serious complications if not treated in time. What symptoms may indicate a pleural hematoma? What is the management of a patient with a pleural hematoma?

Pleural hematomais formed when fluid collects in the pleural cavity. The pleural cavity is the small even space between the visceral membrane (covering the lungs) and the parietal membrane (lining the inside of the thorax, mediastinum and the top of the diaphragm). Normally, there is a small amount of fluid in the pleural cavity, about 5-15 ml. When it increases to 400 ml, it is called a small hematoma, 400-1500 ml is medium, and a large hematoma may exceed 1.5 l. It is worth adding that a small hematoma usually does not give any symptoms.

When diagnosing a pleural hematoma, one more factor is important - hematocrit, i.e. the blood content in the fluid. Hematocrit is the ratio of the erythrocyte volume to the total blood volume or the ratio of all morphotic elements of the blood to its volume. For pleural hematoma, the hematocrit must be at least 50% of the peripheral blood hematocrit, which is different from the bloody exudate, most often caused by a malignant tumor or pulmonary infarction (low hematocrit).

How is a pleural hematoma formed?

Pleural hematoma occurs mainly in the event of a mechanical injury to the chest, such as a rib fracture, or of surgical intervention in the lung, such as a biopsy. Other, but very rare, causes may be some inflammatory processes, cancer, connective tissue diseases or circulatory failure. However, most often it is the above-mentioned trauma, in which the vessels are damaged.

Symptoms of pleural hematoma

When the pleural cavity begins to fill - the volume of fluid reaches approx. 1 l - there is pressure on the lungs and on various vessels. This condition can cause:

  • breathing difficulties, shortness of breath - because the lungs cannot expand properly, ventilation is not correct; additionally, blood oxygenation decreases, so the patient is hypoxic
  • feeling of tightness in the chest
  • cough
  • tachycardia, palpitations - as a result of blood loss and lower blood pressure
  • pale skin, anemia shown in the laboratory test. Ischemia deteriorates the work of many organs.
  • general breakdown and anxiety
  • hypovolemic (hemorrhagic) shock - when blood loss is very large and rapid, the organism is unable to provide sufficient blood supply to the organs: hypotension (lowering blood pressure), increased heart rate, impaired consciousness, pale skin, oliguria. Shock is a life-threatening condition that requires immediate hospitalization.

Diagnosis of pleural hematoma

The doctor may suspect a hematoma on the basis of an interview with the patient and auscultation of him. The lowering of the respiratory noise and the suppression of the percussion sound is the first sign that an excessive amount of fluid has accumulated in the pleural cavity. Another research that can confirm this is:

  • morphology (ESR, CRP)
  • Chest X-ray
  • CT (computed tomography) - when a contusion of the lung or the surrounding tissues and a pleural empyema are additionally suspected
  • USG
  • thoracocentesis, i.e. puncture of the pleural cavity and examination of the hematocrit

Treatment of a pleural hematoma

The above symptoms require a quick response. If bleeding into the pleural cavity is suspected, call an ambulance. The patient should undergo pleural drainage. It consists in introducing a drain connected to the suction system into the cavity. This is to empty the cavity, thereby relaxing the lung and returning to normal ventilation. The drain is not removed immediately after the procedure, but is left in the cavity until the volume of the sucked out fluid is less than 200 ml per day.

If drainage is ineffective (this is found when there is further blood loss of more than 400 ml / h for 2-3 hours or 200-300 ml / h for 6 hours after surgery), or there is a suspicion of cardiac tamponade , damage to larger vessels, formation of a necrotic lesion in the pleura or a large air leak from the bronchi, a thoracotomy (opening of the chest) or videotoracoscopy (insertion of a camera into the chest that allows a detailed view of the injuries) is performed.

Complications after pleural hematoma

  • bacterial infection and pleural empyema - this is due to the fact that each wound is a gateway for microbes, so in the case of a hematoma, which is usually caused by trauma, the risk of infection is high.
  • pleural fibrosis - when appropriate treatment is not implemented on time. Fibrosis is associated with other disorders, such as: breathing abnormalities, retention of secretions, atelectasis, development ofright ventricular failure.
Worth knowing

Shortly after insertion of the tubing, the patient should begin breathing exercises - deep breaths and exhalations in different body positions - and continue these exercises until the tubing is removed. This will strengthen the respiratory muscles and improve ventilation. In addition, exercise ensures that the secretion does not linger and the risk of atelectasis is reduced - so recovery is much faster.

Category:

Cardiology