Blood in the thorax is shown by a uniform area without flocculation. Pleural effusions without blood are usually hypoechoic. Echogenicity is indicated by cellular debris and/or fibrin. Bloody pleural effusions are shows by a swirling, hyperechoic pattern. When a stethoscope is used (auscultation), the heartbeat sounds are faint. When percussion is performed, it produces a dull area. However, especially in traumatic cases, percussion may be painful. Although nonspecific, physical examinations may show reduced lung sounds and muffled, widespread heart sounds. Similar signs and symptoms may occur when other fluids are in the pleural cavity.Treatment includes correction of the underlying cause. Drainage is not always required, but can be performed in case of infection or fluid levels resulting in respiratory compromise. However, drainage in contraindicated in cases caused by clotting disorders. Additionally, broad spectrum antibiotics can be given in the case of open trauma or pulmonary rupture. Supportive care may be required. It may include intranasal oxygen, painkillers, blood transfusions, and fluids. In order to avoid fluid overload, fluids are given slowly.The prognosis significantly depends on the underlying cause of the hemothorax. In cases caused by uncomplicated thoracic trauma, the prognosis may be good, but the prognosis is worse in cases that are complicated by pleuritis. Cases caused by cancer or clotting disorders have a poor prognosis, as do cases with massive bleeding due to injury to the heart or very large blood vessels. References


== External links ==
Dermatosis papulosa nigra (DPN) is a condition of many small, benign skin lesions on the face, a condition generally presenting on dark-skinned individuals. : 638–9  DPN is extremely common, affecting up to 30% of Black people in the US. From a histological perspective, DPN resembles seborrheic keratoses. The condition may be cosmetically undesirable to some. They should not be confused for Leser-Trélat sign, a sudden explosion of lesions due to a growing tumor. Pathophysiology
The pathophysiology of DPN is unknown. Evidence of family history may suggest a genetic propensity. Treatment
DPN lesions are benign and no treatment generally is indicated unless lesions are cosmetically undesirable. Surgical options including curettage, cryotherapy and laser therapy are options. Scarring, postoperative skin discoloration or keloid formation are potential complications. Therefore, conservative DPN treatment is advisable. Prognosis
DPN is not a pre-malignant condition nor is it associated with any underlying systemic disease. DPN lesions show no tendency to regress spontaneously, and often increase in size and number as an individual ages. Epidemiology
DPN affects up to 35% of the African American population in the USA. Insufficient data is available on the international frequency of DPN. Lesions generally emerge during puberty, increasing steadily in number and size as an individual ages. The incidence of DPN lesions increases with age. Black people with a fair complexion have the lowest frequency of involvement. DPN also occurs among Asians and Polynesians, although the exact incidence is unknown. Females are affected more frequently than males.