HAEMOTHORAX AND ITS CLINICAL FEATURES

Haemothorax usually res ult injuryor from penetrating blunt trauma to the chest. Occasionally, haemothoraxdevelops without trauma. Such spontaneous haemothorax, almost always left sided, can occur with acute aorticdissection. Bleeding can occur with a pneumothorax, fromthe rupture of vessels within the pleural adhesions, and somecases air can be absorbed during ofpresentation. Bleeding disorders, heparin therapy, vascularpleural metastases and pleural endometriosis are rarecauses of haemothorax. Haemothoraces, except for a small andstable, should be discharged from the wide-bore intercostal tubeintroduced in midaxilla and connected to underwaterseal. If bleeding persists, the patient requires thoracotomy.If blood is not removed from the pleural space, the infection progresses to empyema can be complication.In long intense fibrous reaction to undrainedblood occasionally can lead to grossly thickened pleuraand encased the lungs, which then requires decortication ifthere not be ventilation is an essential value.

Chylothorax usually follows rupture thethoracic canal after trauma, especially during thoracicsurgery. Damage to the thoracic duct in the lower half ofthe mediastinum causing right-sided chylothorax, whereasdamage the channel in the upper mediastinum products aleft chylothorax. When chylothorax is not due to trauma, malignancy involving thoracic duct is the most commoncause, particularly metastatic disease from carcinoma ofthe stomach, and lymphomas. Rarely cancomplicate chylothorax chylous ascites.Patients with chylothorax present symptomsand signs of pleural effusion and diagnosis of major isonly apparent after aspiration of milky white fluid. Liquids reaccumulates quickly, and repeated drainagesoon leads to severe wasting, hypoproteinaemia andlymphopenia.In to 50% of patients with chylothorax is spontaneoushealing of fistulas, but if it does not theprognosis is poor, unless the flow of chyle can stopped.Following lymphangiogram diagnosis is useful to determinethe site of the fistula, if the leak showed thepatient should be submitted to thoracotomy and ligationof thoracic duct below the leak. If you can not leak on lymphangiography bedemonstrated, repeated aspirations isperformed and the patient is supported by parenteralfeeding, hoping to heal fistulas spontaneously.When healing does not take place, pleural drainage combinedwith pleurodesis sometimes successful.