What is the physiologic resolution of hemothorax?

Updated: Jul 13, 2020
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Jeffrey C Milliken, MD  more...
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Blood that enters the pleural cavity is exposed to the motion of the diaphragm, the lungs, and other intrathoracic structures. This results in some degree of defibrination of the blood so that incomplete clotting occurs. Within several hours of cessation of bleeding, lysis of existing clots by pleural enzymes begins.

Lysis of red blood cells results in a marked increase in the protein concentration of the pleural fluid and an increase in the osmotic pressure within the pleural cavity. This elevated intrapleural osmotic pressure produces an osmotic gradient between the pleural space and the surrounding tissues that favors transudation of fluid into the pleural space. In this way, a small and asymptomatic hemothorax can progress into a large and symptomatic bloody pleural effusion.

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