What is the anatomy of intrapleural injury in hemothorax?

Updated: Jul 13, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Jeffrey C Milliken, MD  more...
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Answer

Blunt or penetrating injury involving virtually any intrathoracic structure can result in hemothorax. Massive hemothorax or exsanguinating hemorrhage may result from injury to major arterial or venous structures contained within the thorax or from the heart itself. These include the aorta and its brachiocephalic branches, the main or branch pulmonary arteries, the superior vena cava and the brachiocephalic veins, the inferior vena cava, the azygos vein, and the major pulmonary veins.

Injury to the heart can produce a hemothorax if a communication exists between the pericardium and the pleural space.

Injury to the pulmonary parenchyma may cause hemothorax, but it is usually self-limited because pulmonary vascular pressure is normally low. Pulmonary parenchymal injury is usually associated with pneumothorax and results in limited hemorrhage.

Hemothorax resulting from metastatic malignant disease is usually from tumor implants that seed the pleural surfaces of the thorax.

Diseases of the thoracic aorta and its major branches, such as dissection or aneurysm formation, account for a large percentage of specific vascular abnormalities that can cause hemothorax. Aneurysms of other intrathoracic arteries such as the internal mammary artery have been described and are possible causes of hemothorax if rupture occurs.

A variety of unusual congenital pulmonary abnormalities, including intralobar and extralobar sequestration, [4] hereditary telangiectasia, and congenital arteriovenous malformations, can cause hemothorax.

Hemothorax can result from a pathologic process within the abdomen if blood escaping from the lesion is able to traverse the diaphragm through one of the normal hiatal openings or a congenital or acquired opening.


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