Background
Most rib fractures are treated conservatively, but patients with severe trauma may require surgical treatment. We report a rare case of delayed pericardial injury due to a fractured rib stump.
Case presentation
A 61-year-old man fell while riding a bicycle and was transferred to our hospital. A computed tomography (CT) scan showed mild rib fractures on the 4th-6th ribs, and he was hospitalized because of acute pain. A few days later, his respiratory condition had worsened. CT showed that the rib fractures progressed significantly, and the stump was in contact with the heart, so we performed an urgent surgical rib fixation. Operative findings revealed intrathoracic hemorrhage by the pericardial laceration because of the rib stump. The 4th-7th ribs were internally fixed using a screwless titanium metal plate, and he was discharged without complications on the 20th postoperative day.
Conclusion
We experienced a rare case of pericardial injury caused by a rapid dislocation of rib fractures. Urgent surgical treatment was able to prevent a serious complication.
A 77-year-old woman was referred to our hospital due to abnormal findings on a chest radiograph. Contrast-enhanced computed tomography (CT) showed a 25-mm nodule in the posterior mediastinum that was identical to the azygous vein in its shape and contrast effect. We diagnosed this as azygos vein aneurysm. Video-assisted thoracic surgery was performed to resect the aneurysm. The proximal end of the azygos vein aneurysm was initially dissected to reduce the risk of pulmonary embolism. Histological examination of the resected tissue revealed a saccular dilation of the vein with mixed thick and thin walls containing both fresh and organized thrombi in the lumen. In this case, preoperative enhanced CT showed no apparent thrombosis in the azygos vein aneurysm. Removing the azygos vein aneurysm at an early stage is desirable because thrombosis in an azygos vein aneurysm may not be detected by imaging. This finding also suggested that the proximal end of an azygos vein aneurysm should be resected first to reduce the risk of thromboemboli.
A 64-year-old man visited a neighboring hospital with the chief complaint of left back pain, upon which chest X-ray images and a chest CT scan revealed fluid accumulation due to left pleural effusion. The patient was thus referred to our department under a suspicion of empyema. Empyema was also suspected on chest CT findings at our hospital, leading to the initiation of continuous drainage by placing a chest tube. The pleural effusion was pale-bloody but not purulent, with a shadow remaining in the upper left mid-lung area even after the drainage. With mild inflammatory reactions revealed upon blood exams, thoracoscopic surgery was carried out for the purpose of diagnostic treatment taking the possibility of diseases other than empyema, such as hematomas and tumors, into account. The thoracic findings revealed no hematoma inside the chest but a bulge of approximately 14 cm in diameter along the parietal pleura. A clot filling the parietal pleura was observed upon incision and it was diagnosed as a chest wall hematoma. The parietal pleura of the bulging part was resected and the clot was curetted ; however, no obvious bleeding point was confirmed. Recurrent bleeding was not observed from the chest walls and the patient was discharged from our hospital on Day 14 following the surgery. Approximately two years have passed since the surgery and no recurrent bleeding has been observed. The patient had no precritical histories of receiving surgeries, injuries and administration of anticoagulation agent, indicating that he had no predisposing factors for bleeding tendency. We report an rare case of acute spontaneous chest wall hematoma forming a mass in the thorax. Key words:acute spontaneous chest wall hematoma,thracoscopic surgery
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.