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.

Figure 1

Preoperative images. (A) Chest X-ray film showing left tension hemothorax; (B) Enhanced chest computed tomography (CT) shows left hemothorax and bleeding into the thoracic space from a branch of the left inferior phrenic artery without involvement of the abdomen in the delay phase; (C) Note the leak of contrast medium into the thoracic space on angiography of the selected left phrenic artery; (D) Bleeding was markedly reduced after coil embolization.

Figure 2

Intra-operative schematic illustration of the left thoracic cavity. Note the blood vessel considered to be a branch of the inferior phrenic artery of the diaphragm surface without obvious lung damage, rib fracture or diaphragm rupture.