Report of a rare case: occult hemothorax due to blunt trauma without obvious injury to other organs

Abstract

Traumatic hemothorax commonly occurs accompanied by organ damage, such as rib fractures, lung injury and diaphragm rupture. Our reported patient was a 61-year-old man who fell down from a stepladder about 1 meter in height, resulting in a heavy blow to the left abdomen. He consulted a clinic because of left chest pain the next day and was transported to the emergency center of our hospital on diagnosis of hemothorax with hemorrhagic shock.On computed tomography scanning with contrast medium, left hemothorax without rib fracture, diaphragm rupture or obvious organ injury was evident. We found only bleeding to the thoracic space from a branch of the left inferior phrenic artery without involvement of the abdomen. The patient underwent percutaneous angiography and embolization for hemostasis, and subsequently thoracotomy in order to check the active bleeding and remove the hematoma to improve respiratory. As thoracotomy findings, we found damage of a branch of the left inferior phrenic artery to the thoracic space without diaphragm rupture, and sutured the lesion. Such active intervention followed by surgical procedures was effective and should be considered for rare occurrences like the present case. We must consider not only traumatic diaphragm rupture, but also vascular damage by pressure trauma as etiological factors for hemothorax.

Life- threatening hemothorax due to the inferior pulmonary ligament injury without obvious organ injuries: a case report

“…Most common cause of a hemothorax is trauma [ 1 - 3 ]. Traumatic hemothorax is usually consequence of other organ damage, such as chest wall, the lung paremchyme and the tracheobronchial tree, the esophagus, the diaphragm, and the heart or great vessels [ 1 , 2 ].…”

“…Traumatic hemothorax is usually consequence of other organ damage, such as chest wall, the lung paremchyme and the tracheobronchial tree, the esophagus, the diaphragm, and the heart or great vessels [ 1 , 2 ]. Thoracic distortion and shearing after blunt trauma to the chest can result in the injuries in any one or all structures of the thoracic cavity and the chest wall [ 3 ]. Also, laceration of internal vessels by blunt trauma can occasionally result in hemothorax [ 1 - 3 ].…”

“…Thoracic distortion and shearing after blunt trauma to the chest can result in the injuries in any one or all structures of the thoracic cavity and the chest wall [ 3 ]. Also, laceration of internal vessels by blunt trauma can occasionally result in hemothorax [ 1 - 3 ].…”

Management of Blunt Chest Injury

“…All these intrathoracic injuries may cause haemothorax and/ or pneumothorax, the most common complication that can occur immediately after blunt chest injury. 3 The mechanism of injury should also influence the index of suspicion for these critical injuries.…”

Traumatic Extrapleural Hematoma Mimicking Hemothorax

“…After blunt chest injuries, patients may have chest wall destruction and lung parenchymal injuries. These injuries may cause hemothorax or pneumothorax, the most common complication that can occur immediately after blunt chest trauma [2]. Rarely, chest injury may result in a collection of blood between the parietal pleura and the endothoracic fascia, named extra-pleural hematoma [3].…”