hemothorax

Définition

Un hémothorax est la présence de sang à l'intérieur dans la plèvre pulmonaire.
La plèvre pulmonaire est constituée des membranes de recouvrement  et de protection des poumons (voir notre vidéo sur les poumons).

Les causes de l'hémothorax sont (liste non exhaustive) :
  • Un traumatisme du thorax.
  • Les problèmes liés à la coagulabilité du sang et plus précisément l'hémostase (première partie de la coagulation sanguine).
  • Un cancer.
  • L'atteinte d'une artère intercostale pour différentes raisons.
  • La rupture d'un anévrisme de l'aorte.

Symptômes

Les symptômes de l'hémothorax sont identiques à ceux d'une pleurésie.
Il en est de même des signes radiologiques
En ce qui concerne l'hémothorax massif celui-ci est susceptible d'évoluer vers un état de choc dont l'évolution est péjorative pour le patient, pour lequel une prise en charge thérapeutique en réanimation est nécessaire sans quoi le décès est possible

Traitement

Le traitement de la cause de l'hémothorax est nécessaire.
Les transfusions sanguines sont le plus souvent utiles, étant données les pertes sanguines.

Le drainage par une dépression d'eau est quelquefois effectué par certaines équipes spécialisées en pneumologie.

Le drainage chirurgical doit être effectué de manière complète. Quand ce n'est pas le cas, le patient risque de voir survenir la formation d'un fibrothorax, c'est-à-dire d'une perte d'élasticité à ce niveau, ce qui nécessite une intervention chirurgicale de type décortication pleurale.

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