Hemothorax

Etiology

Bleeding into the chest cavity most commonly occurs after chest trauma, either blunt or penetrating. It can be the result of iatrogenic trauma, including surgical procedures and venous line insertion. Hemothorax can also result from erosion of a blood vessel in association with inflammatory processes such as tuberculosis and empyema. It may complicate a variety of congenital anomalies including sequestration, patent ductus arteriosus, and pulmonary arteriovenous malformation (see Fig. 436.2 in Chapter 436 ). It is also an occasional manifestation of intrathoracic neoplasms, costal exostoses, blood dyscrasias, bleeding diatheses, or thrombolytic therapy. Rupture of an aneurysm is unlikely during childhood. Hemothorax may occur spontaneously in neonates and older children but is very rare. A pleural hemorrhage associated with a pneumothorax is a hemopneumothorax; it is usually the result of a ruptured bulla with lung volume loss causing a torn pleural adhesion.