Which finding is most consistent with a hemothorax?

• A. Cyanosis, tracheal shift and bruising away from affected side
• B. Tachypnea
• C. Hemoptysis
• D. Diminished/absent breath sounds on affected side

Answer: (C)

Blood in the pleural space causes the lung on the affected side to collapse or be compressed, so less air reaches the chest wall. The most telling physical sign is diminished or absent breath sounds on the side of the chest with the effusion. You may also hear dullness to percussion there due to the fluid, and tachypnea often accompanies the respiratory distress. Hemoptysis, or coughing up blood, points more toward bleeding within the airways or lung tissue itself rather than the pleural space, so it is not the best clue for a hemothorax. Tracheal shift away from the affected side suggests a tension pneumothorax, not a simple hemothorax. So the finding that best fits a hemothorax is diminished/absent breath sounds on the affected side.