Nomenclature, Classification, and Significance of Traumatic Extrapleural Hematoma

Abstract

Extrapleural hematoma has been found to be more common than previously reported. Nomenclature and classification are suggested. One of the common injuries to the chest, particularly rib fracture, hemothorax, lung contusion, or pneumothorax might provide the surgeon with a reliable clinical clue that the patient is at inordinate risk to have associated extrapleural hematoma. A formal or mini-thoracotomy is the recommended procedure in cases of huge hematomas.

Extrapleural hematoma cases treated with video-assisted thoracic surgery

“…[5] Minor injuries in mediastinal structures, traumatic aortic rupture and vertebral and rib fractures are the other bleeding sources. [1] Among the differential diagnosis are encysted pleural effusion, pleural tumors, peripheral lung tumors, oleothorax, round atelectasis and diaphragmatic hernias. [1,6] …”

“…[1] Among the differential diagnosis are encysted pleural effusion, pleural tumors, peripheral lung tumors, oleothorax, round atelectasis and diaphragmatic hernias. [1,6] …”

“…When the posteroanterior and lateral chest radiographies reveal a D-shaped opacity on the chest wall, thoracic CT is performed, and the detection of the progression of the extrapleural fat tissue into the thorax and the dislocation of the parietal pleura (extrapleural fat sign) confirm the diagnosis. [1][2][3] Chung et al [7] have classified EPH in two groups; biconvex and nonconvex. They have defined that biconvex EPHs have larger diameters and possibly develop due to arterial injury, while nonconvex EPHs have smaller diameters and develop due to bleedings with lower pressure.…”

“…EPH is classified into three groups including spontaneous, iatrogenic and traumatic. [1] Blunt chest trauma, central venous catheterization and ruptured thoracic aortic aneurysm are the most frequent etiological factors. Rashid et al have reported that the incidence of EPH in thoracic trauma is 7.1%, and the mortality rate in the early period is 2.9%.…”

“…Rashid et al have reported that the incidence of EPH in thoracic trauma is 7.1%, and the mortality rate in the early period is 2.9%. [1] Diagnostic evidence in thoracic computed tomography are the observation of extrapleural fat sign, namely, separation of parietal pleura from endothoracic fascia and medial translocation, and fluid accumulation in the area. [2,3] In this article, three patients diagnosed with extrapleural hematoma and treated with VATS (video-assisted thoracoscopic surgery) were presented by reviewing the literature.…”