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Hemothorax: Bleeding in the Chest in Dogs

By: Dr. Douglas Brum

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Hemothorax is defined as blood within the chest cavity. The most common cause of hemothorax is chest trauma, although tumors within the thorax (chest cavity) can also result in a hemothorax if they rupture, slowly bleed or invade into a blood vessel causing blood to accumulate in the thorax. Coagulopathies (clotting disorders) may also cause an animal to bleed within the chest cavity. A hemothorax is usually an emergency situation requiring rapid diagnosis.

What to Watch For

  • Difficulty breathing
  • Increased panting
  • Weakness
  • Collapse
  • Pale mucus membranes (the best place to check is the gums or inner lining of the lips)

    Your dog may take short, shallow, rapid breaths. Look for any observable subcutaneous (under the skin) bruising or evidence of external trauma.

    Diagnosis

    A thorough history and complete physical exam, emphasizing lung auscultation (listening with a stethoscope), is essential for prompt and accurate diagnosis. Your veterinarian may also recommend:

  • Thoracic radiographs (x-rays)

  • Thoracentesis (inserting a needle and syringe into the chest cavity through the skin) to obtain a sample of fluid for definitive diagnosis. Fluid analysis is performed on the aspirated fluid sample.

  • Complete blood count (CBC)

    The above tests are generally the minimum required diagnostic tests needed to obtain a diagnosis. Depending on the animal's condition, and initial test results, additional tests that may be required include:

  • Biochemical profile
  • Arterial blood gas analysis
  • Thoracic or cardiac ultrasound
  • Clotting tests including an activated clotting time (ACT), a prothombin time (PT), activated partial thromboplastin time (APTT), platelet count, and possible a von Willebrands (VWF) test

    Treatment

    General approach to treatment varies depending on the clinical condition of the patient.

  • Thoracentesis, while a diagnostic aid, is also an important treatment as fluid in the chest is slowly removed
  • Chest tube placement and period or constant suctioning of chest fluid
  • Intravenous fluid therapy
  • Blood transfusions
  • Oxygen therapy
  • Analgesic medication (pain medications)
  • Vitamin K therapy
  • Emergency thoracotomy (chest surgery) is occasionally required if the bleeding cannot be stopped and the clotting tests are normal. This is most commonly needed with penetrating chest wounds or bleeding tumors.

    Home Care

    A hemothorax is generally an emergency situation. Veterinary care should be given as soon as possible. Keep your pet calm and comfortable and minimize stress. Keep your pet warm, and if a traumatic injury is suspected, be careful moving your pet, as fractures may be present.

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