Rapidly expanding extrapleural hematoma

Abstract

We present a rare case of extrapleural hematoma due to chest trauma in an anticoagulated male patient. Chest computed tomography revealed multiple left rib fractures and a D-shaped opacity in the upper left side of the thorax suggesting extrapleural hematoma, which was caused from continuous bleeding. His past history included alcoholic liver cirrhosis, which caused thrombocytopenia and coagulopathy. Therefore, the hematoma was expanding, causing circulatory and ventilatory disturbance and severe anemia despite the difficulty of expanding in the extrapleural space. As the bleeding did not stop, even after intercostal artery angiography with embolization was performed, surgical treatment was undertaken to control the bleeding and evacuate the huge hematoma. The problems associated with the diagnosis and treatment of an extrapleural hematoma are discussed in the light of this case.

Hemoperitoneum secondary to intercostal arterial bleeding in a trauma patient

“…For patients presenting with rapidly expanding extrapleural hematomas, hemodynamic instability, or persistent bleeding from intercostal arterial branches, options for intervention include transcatheter arterial embolization (TAE) or surgical exploration [1, 4]. TAE has been reported as a safe and reliable technique in the management of blunt intercostal arterial injury associated with clinical deterioration [1].…”

“…There are multiple reports of intercostal arterial bleeding resulting in abdominal wall hematomas [2] and hemothorax [1] that require embolization [3] or even thoracotomy [4]. To our knowledge however, this is the first description in the literature demonstrating hemoperitoneum from intercostal arterial bleeding requiring laparotomy.…”

Extrapleural Hematomas

“…Other etiologies include penetrating trauma, aortic rupture, and iatrogenic injuries. [2][3][4][5][6][7] In the setting of blunt trauma, it is theorized that vascular disruption is the main cause of extrapleural hemorrhage, although hematomas associated with fractures alone may also result in an EPH. 2 When the chest wall is injured, the parietal pleura is often also injured, resulting in a typical hemothorax; the FIGURE 3.…”

Multidetector computed tomography of chest trauma: indications, technique and interpretation

“…When extrapleural hematoma is caused by injury of the intercostal artery, it is a potentially life-threatening condition [30]. It occurs relatively rarely as a result of the chest wall injury or a complication of interventions (drainage, insertion of the central venous catheter) [31–33].…”