Hemothorax is a collection of bloody fluid in the pleural space with a hematocrit at least 50% of the peripheral blood. Hemothorax is most commonly caused by trauma and rarely due to malignancy or pulmonary embolism. Hemothoraces are commonly encountered in clinical practice and may need to be drained depending on their size and effect on gas exchange. Diagnosis hinges on the clinical setting and confirmation by pleural fluid analysis. Apposition of the parietal and visceral pleura by drainage may arrest intrapleural bleeding via tamponade. Thoracoscopy and thoracotomy may be required if drainage alone is unsuccessful. The pathogenesis of large hemothoraces can involve progressive organization and fibrosis leading to lung restriction, arguing for the removal of this fibrotic encasement. Intrapleural thrombolytic therapy is an alternative approach to address organizing hemothoraces.