Clotting abnormalities, such as those caused by anticoagulant medications, should be reversed. Prophylactic antibiotics are given for 24 hours in the case of trauma. Blood clots may be retained within the pleural cavity despite chest tube drainage. They are a risk factor for complications like fibrothorax and empyema. Such retained clots should be removed, preferably with video-assisted thoracoscopic surgery (VATS). If VATS is unavailable, an alternative is fibrinolytic therapy such as streptokinase or urokinase given directly into the pleural space seven to ten days after the injury. The issues with fibrinolytic therapy include having a high cost and lengthened hospital stay. Residual clot that does not dissipate in response to fibrinolytics may require surgical removal in the form of decortication. Prognosis
The prognosis following a hemothorax depends on its size, the treatment given, and the underlying cause. While small hemothoraces may cause little in the way of problems, in severe cases an untreated hemothorax may be rapidly fatal due to uncontrolled blood loss. If left untreated, the accumulation of blood may put pressure on the mediastinum and the trachea, limiting the hearts ability to fill. However, if treated, the prognosis following a traumatic hemothorax is usually favourable and dependent on other non-thoracic injuries that have been sustained at the same time, the age of the person, and the need for mechanical ventilation. Hemothoraces caused by benign conditions such as endometriosis have a good prognosis, while those caused by neurofibromatosis type 1 has a 36% rate of death, and those caused by aortic rupture are often fatal.
Endometriotic tissue that implants on the pleural surface can bleed in response to the hormonal changes of the menstrual cycle, causing what is known as a catamenial hemothorax as part of thoracic endometriosis along with catamenial pneumothorax, catamenial hemoptysis, and lung nodules of endometriosis. Catamenial hemothorax represents 14% of cases of thoracic endometriosis syndrome while catamenial pneumothorax is seen in 73%, catamenial hemoptysis in 7%, and pulmonary nodules in 6%. Mechanism
When a hemothorax occurs, blood enters the pleural cavity. The blood loss from the circulation has several effects. Firstly, as blood builds up within the pleural cavity, it begins to interfere with the normal movement of the lungs, preventing one or both lungs from fully expanding and thereby interfering with the normal transfer of oxygen and carbon dioxide to and from the blood. Secondly, blood that has been lost into the pleural cavity can no longer be circulated. Hemothoraces can lead to significant blood loss – each half of the thorax can hold more than 1500 milliliters of blood, representing more than 25% of an average adults total blood volume. The body may struggle to cope with this blood loss, and tries to compensate by maintaining blood pressure by forcing the heart to pump harder and faster, and by squeezing or constricting small blood vessels in the arms and legs. These compensatory mechanisms can be recognised by a rapid resting heart rate and cool fingers and toes.If the blood within the pleural cavity is not removed, it will eventually clot.