Hemothorax has a variety of causes. A distinction needs to be made between bloodstained pleural effusion and true hemothorax. When hemorrhage has occurred in the pleural space, there are changes in the blood's consistency when it is removed sometime later. Unless removal is immediate the hematocrit is not the same as the blood in the circulation. Various arbitrary hemoglobin levels have been quoted as the lower level for determining true hemothorax. Such levels are of doubtful value, but frequently hemothorax is regarded as a collection in the pleural space with a hemoglobin of more than 7 g/dl. The causes given in Table 1 and are those that may be considered when a pleural aspiration reveals blood. Where the patient is stable, an aspirate with a hemoglobin as high as the circulating blood may indicate that the aspirating needle has entered an intercostal vessel and the blood usually clots unless there is a coagulopathy.

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Table 1 Common etiologies of hemothorax

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Table 2 Unusual causes in the critical care area

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