What Is Hemothorax?

Medically Reviewed by Melinda Ratini, MS, DO on August 09, 2023
4 min read

Hemothorax is bleeding and blood accumulating around your lung. This usually happens after an injury to the chest area. Some underlying health conditions can lead to bleeding in the chest cavity, as well.

Your lungs sit in your chest cavity, right behind your rib cage and on either side of your heart. They are encased by a protective tissue called the pleura. There are multiple blood vessels in and around the lungs, including major arteries that lead away from the heart.

If any of the blood vessels in the chest cavity are damaged, they may leak blood. In the case of a hemothorax, the bleeding fills the space between the lung itself and the pleura membrane that surrounds it. The severity of the condition depends on how much bleeding there is and how quickly it stops.

Hemothorax can be minor and heal without any problem. Sometimes, if the bleeding is severe and treatment is delayed, it may be life-threatening.

The most common cause of hemothorax is an injury to your chest area, such as the type of injury you might get in a car accident. Any trauma to the area can cause bleeding inside your chest cavity, even if you don’t have bleeding that you can see. The hemothorax bleeding itself may not be painful, but you will likely have pain from the injury.

In some cases, you can have bleeding that isn’t linked to trauma. This is called a spontaneous hemothorax. There are some health conditions that can cause bleeding around the lungs, including:

Bleeding can also be a complication of some medical procedures, such as surgery on the lungs or heart, or injury to a blood vessel when you get a central venous catheter.

The first symptom of hemothorax is often the chest injury that caused it. If you have experienced significant trauma to your chest, seek emergency medical attention. You may need immediate treatment for the injury as well as follow-up tests to see if you have internal bleeding. The longer internal bleeding goes on without treatment, the greater your risk of death.

You may not know right after the injury that you have bleeding around your lungs. Some signs that you have bleeding inside your chest cavity include:

  • Trouble breathing or shortness of breath
  • Chest pain
  • Shock symptoms such as nausea, fatigue, and confusion
  • Pale, cool, and clammy skin
  • Rapid heart rate
  • Rapid, shallow breathing
  • Restlessness and anxiety

Get emergency medical attention if you have any of the above symptoms or if you experience the following:

  • Dizziness or lightheadedness
  • Fever and cough
  • A sensation of heaviness in your chest
  • Severe chest, neck, jaw, shoulder, or arm pain
  • Difficulty breathing

If you have a severe injury, doctors will take care of that first. Once you’re stabilized, they will look for signs of hemothorax. Your doctor may check your blood pressure, heart rate, and breathing. You may also need X-rays to see if there is bleeding in your chest. In some cases, your doctor will use a needle to extract fluid from your chest to see if there is evidence of bleeding.

Once your diagnosis is confirmed, your doctor will treat your symptoms. In some cases, the bleeding is minor and stops on its own. When this happens, you may not need any treatment beyond care for your original injury. Your doctor may offer you medicine for pain.

Sometimes, hemothorax or the injury that causes it results in a collapsed lung. If that happens, you will need a chest tube to inflate your lung. This tube will remain in place for several days to keep the lung inflated and to drain any blood or fluid that has built up.

If you’re having difficulty breathing or you have lost a lot of blood, you may need procedures to address these issues, such as: ‌

  • Breathing support, including oxygen, intubation, or a ventilator
  • Blood transfusion
  • Intravenous (IV) fluids
  • Chest tube to drain the blood

In severe cases, you may need surgery to stop the bleeding and clear the fluid out of your chest. You will need to be under general anesthesia for this procedure. Your doctor will open your chest wall to find the source of the bleeding and repair the damaged blood vessels. They will also remove any blood and fluid from around your lungs.

Your recovery from hemothorax will depend on how serious your other injuries were. If you need a chest tube or surgery, you will need to stay in the hospital for a few days. Your doctor will tell you what kind of care you need during your recovery and when you can resume normal activities.