“…Spinal fixation was undertaken in six cases, including our case [ 8 – 10 , 12 , 16 ]. With the exception of one case wherein spinal fixation was done on the day of massive rebleeding as a definitive surgery [ 8 ], spinal fixation was undertaken as a planned definitive surgery between 1 and 10 days following hospitalization [ 9 , 10 , 12 , 16 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“… – NR Not performed Dead Masteller/ 2012 [ 11 ] 71 M Transfer in OR T11 / burst none unstable (CPA later) Right 3000 Only thoracentesis. – NR Not performed Dead Okamoto/ 2018 [ 12 ] 81 M Fall T7 / Chance NR stable (unstable later) Right 1330 Right thoracotomy bone wax, coagulant sheet NR Performed Survived Hirota/ 2019 [ 9 ] 74 F Fall T11 / Chance none unstable Right 1200 Right thoracotomy coagulant sheet NR Performed Survived Kaneko/ 2000 [ 14 ] 86 F Unclear T6 / dislocation NR unstable Right 2000 Right thoracotomy argon beam, iliopsoas muscle flap NR Not performed Dead Matsushita/ 2016 [ 16 ] 67 M Hit by a lumber T3 / dislocation chest, T12 Fx (dislocation), limb unstable Bilateral 2090 Right thoracotomy coagulant sheet NR Performed Survived Haruta/ 2016 [ 15 ] 78 F Traffic accident ...…”
Section: Resultsmentioning
confidence: 99%
“…After screening and application of our inclusion criteria, only 9 articles (six in English and three in Japanese) were included ( Fig. 3) [8][9][10][11][12][13][14][15][16]. Details of 12 cases, including the above-described patients, are shown in Table 1.…”
Background
Massive hemothorax secondary to thoracic spinal fractures is rare, and its clinical characteristics, treatment, and prognosis are unknown. We present two cases of thoracic spinal fracture-induced massive hemothorax and a systematic review of previously reported cases.
Methods
This study included patients with traumatic hemothorax from thoracic spinal fractures at a Japanese tertiary care hospital. A systematic review of published cases was undertaken through searches in PubMed, EMBASE, and ICHUSHI from inception to October 13, 2019.
Results
Case 1: An 81-year-old man developed hemodynamic instability from a right hemothorax with multiple rib fractures following a pedestrian–vehicle accident; > 1500 mL blood was evacuated through the intercostal drain. Thoracotomy showed hemorrhage from a T8-burst fracture, and gauze packing was used for hemostasis. Case 2: A 64-year-old man with right hemothorax and hypotension after a fall from height had hemorrhage from a T7-burst fracture, detected on thoracotomy, which was sealed with bone wax. Hypotension recurred during transfer; re-thoracotomy showed bleeding from a T7 fracture, which was packed with bone wax and gauze for hemostasis. The systematic review identified 10 similar cases and analyzed 12 cases, including the abovementioned cases. Inferior part of thoracic spines was prone to injury and induced right-sided hemothorax. Most patients developed hemodynamic instability, and some sustained intra-transfer hemorrhage; direct compression (gauze packing, bone wax, and hemostatic agents) was the commonest hemostatic procedure. The mortality rate was 33.3%.
Conclusions
Hemothorax due to thoracic spinal fracture can be fatal. Thoracotomy with direct compression is necessary in hemodynamically unstable patients.
“…Spinal fixation was undertaken in six cases, including our case [ 8 – 10 , 12 , 16 ]. With the exception of one case wherein spinal fixation was done on the day of massive rebleeding as a definitive surgery [ 8 ], spinal fixation was undertaken as a planned definitive surgery between 1 and 10 days following hospitalization [ 9 , 10 , 12 , 16 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“… – NR Not performed Dead Masteller/ 2012 [ 11 ] 71 M Transfer in OR T11 / burst none unstable (CPA later) Right 3000 Only thoracentesis. – NR Not performed Dead Okamoto/ 2018 [ 12 ] 81 M Fall T7 / Chance NR stable (unstable later) Right 1330 Right thoracotomy bone wax, coagulant sheet NR Performed Survived Hirota/ 2019 [ 9 ] 74 F Fall T11 / Chance none unstable Right 1200 Right thoracotomy coagulant sheet NR Performed Survived Kaneko/ 2000 [ 14 ] 86 F Unclear T6 / dislocation NR unstable Right 2000 Right thoracotomy argon beam, iliopsoas muscle flap NR Not performed Dead Matsushita/ 2016 [ 16 ] 67 M Hit by a lumber T3 / dislocation chest, T12 Fx (dislocation), limb unstable Bilateral 2090 Right thoracotomy coagulant sheet NR Performed Survived Haruta/ 2016 [ 15 ] 78 F Traffic accident ...…”
Section: Resultsmentioning
confidence: 99%
“…After screening and application of our inclusion criteria, only 9 articles (six in English and three in Japanese) were included ( Fig. 3) [8][9][10][11][12][13][14][15][16]. Details of 12 cases, including the above-described patients, are shown in Table 1.…”
Background
Massive hemothorax secondary to thoracic spinal fractures is rare, and its clinical characteristics, treatment, and prognosis are unknown. We present two cases of thoracic spinal fracture-induced massive hemothorax and a systematic review of previously reported cases.
Methods
This study included patients with traumatic hemothorax from thoracic spinal fractures at a Japanese tertiary care hospital. A systematic review of published cases was undertaken through searches in PubMed, EMBASE, and ICHUSHI from inception to October 13, 2019.
Results
Case 1: An 81-year-old man developed hemodynamic instability from a right hemothorax with multiple rib fractures following a pedestrian–vehicle accident; > 1500 mL blood was evacuated through the intercostal drain. Thoracotomy showed hemorrhage from a T8-burst fracture, and gauze packing was used for hemostasis. Case 2: A 64-year-old man with right hemothorax and hypotension after a fall from height had hemorrhage from a T7-burst fracture, detected on thoracotomy, which was sealed with bone wax. Hypotension recurred during transfer; re-thoracotomy showed bleeding from a T7 fracture, which was packed with bone wax and gauze for hemostasis. The systematic review identified 10 similar cases and analyzed 12 cases, including the abovementioned cases. Inferior part of thoracic spines was prone to injury and induced right-sided hemothorax. Most patients developed hemodynamic instability, and some sustained intra-transfer hemorrhage; direct compression (gauze packing, bone wax, and hemostatic agents) was the commonest hemostatic procedure. The mortality rate was 33.3%.
Conclusions
Hemothorax due to thoracic spinal fracture can be fatal. Thoracotomy with direct compression is necessary in hemodynamically unstable patients.
“…Patients with DISH may suffer from hemothorax caused by spinal fracture. At least 8 of the 19 cases had DISH [ 1 , 4 , 5 , 9 , 13 , 14 ], of which 6 were reverse Chance-type fractures on the basis of the descriptions and images [ 1 , 4 , 5 , 13 , 14 ]. DISH consists of ossification along the anterolateral aspect of at least four contiguous vertebrae and is common among the elderly.…”
Section: Discussionmentioning
confidence: 99%
“…However, all six conservatively treated patients developed worsening hemothorax; four underwent thoracotomy [ 1 , 4 , 7 , 8 ], but one died [ 8 ]. In 13 cases, spinal fixation was eventually required [ 1 – 6 , 10 , 11 , 13 – 15 ]. Spontaneous hemostasis was difficult owing to fracture instability and the lack of a compartmentalization effect resulting from insufficient paravertebral hematoma formation due to thoracic cavity perforation.…”
Background
Spinal fractures rarely cause hemothorax, and no treatment consensus has been reached. Conservative treatment is generally selected in cases without arterial injury, but there have been some reports of uncontrolled bleeding. Here we report a case of hemothorax caused by spinal fracture without arterial injury treated with transcatheter arterial embolization.
Case presentation
An 88-year-old Japanese woman with back pain was diagnosed with hemothorax due to bleeding from an unstable fracture of the tenth thoracic vertebra. Contrast-enhanced computed tomography revealed no obvious arterial injury. We performed transcatheter arterial embolization of the bilateral tenth intercostal arteries to prevent rebleeding. The hemothorax did not worsen until surgical spinal fixation 9 days post-transcatheter arterial embolization, and she was discharged 30 days after admission.
Conclusion
Transcatheter arterial embolization for hemothorax caused by spinal fractures without obvious arterial injury may be a useful bridge to spinal fixation.
Background
Hemothorax occurs in approx. 0.4% of all chest injury patients, but hemothorax due to a thoracic vertebral fracture is rare.
Case presentation
A 76-year-old Japanese man was transported to our hospital for right hemothorax due to a car accident. We performed emergency hemostasis surgery and tried to stop the bleeding by several methods, but it was difficult to control the bleeding because the bleeding point was an artery branch that runs in front of the vertebral body.
Conclusion
It is important to be aware that a fractured vertebra can damage the aorta's arterial branch and follow a severe course.
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.
