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Case Reports
. 2018 Oct 7;12(1):291.
doi: 10.1186/s13256-018-1813-x.

Massive hemothorax due to two bleeding sources with minor injury mechanism: a case report

Koshi Ota  1 , Satoshi Fumimoto  2 , Ryo Iida  3 , Takayuki Kataoka  2 , Kanna Ota  3 , Kohei Taniguchi  3 , Nobuharu Hanaoka  2 , Akira Takasu  3
Affiliations
Case Reports

Massive hemothorax due to two bleeding sources with minor injury mechanism: a case report

Koshi Ota et al. J Med Case Rep. .

Abstract

Background: Massive hemothorax resulting from a minor injury mechanism is considered to be rare particularly when the diaphragm is injured. We report a case of massive hemothorax with bleeding from the intercostal artery and diaphragmatic damage caused by minor blunt trauma.

Case presentation: An 83-year-old Japanese man was transported to our hospital 3 hours after falling out of bed. Computed tomography revealed hemothorax and multiple rib fractures. He underwent fluid resuscitation and a tube thoracostomy, but he became hemodynamically unstable. Contrast-enhanced computed tomography revealed worsening hemothorax with contrast extravasation 4 hours after arrival at the hospital. Emergency angiography indicated hemorrhage in the area supplied by the tenth intercostal artery. Transcatheter arterial embolization stabilized his vital signs for a short period. However, further hemodynamic stabilization required a thoracotomy, which revealed diaphragmatic trauma, which was removed and sutured before fixing his fractured ribs. His postoperative course was uneventful, and he was transferred to another hospital for rehabilitation without complications on hospital day 29.

Conclusions: Minor mechanisms of blunt trauma can cause rib fractures and massive hemothorax. Traumatic diaphragm injury should be considered a differential diagnosis if hemodynamic instability persists after transcatheter arterial embolization in patients with lower level rib fractures.

Keywords: Diaphragm injury; Hemothorax; Injury; Rib fracture.

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Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Chest radiography and computed tomography imaging findings of the patient. Chest radiography on arrival at emergency room shows left hemothorax (a). First computed tomography images show hemothorax (b) and fracture of tenth rib (c). Multiple fractures of 9th to 12th ribs (arrow) are revealed by (d)
Fig. 2
Fig. 2
Contrast-enhanced computed tomography and angiography findings. Contrast-enhanced computed tomography (a) shows increased hemothorax compared with that shown in Fig. 1b. Early-phase and late-phase contrast-enhanced computed tomography images show extravasation of intercostal artery (arrow; b) and increased area of extravasation (arrows; c), respectively, near tenth rib. Angiography (d) shows extravasation (arrow)
Fig. 3
Fig. 3
Diaphragmatic trauma. Site of diaphragmatic injury with oozing from phrenic artery branches during surgery (arrow; a) is removed and site is sutured (arrow; b)
See this image and copyright information in PMC

References

    1. Ogawa F, Naito M, Iyoda A, Satoh Y. Report of a rare case: occult hemothorax due to blunt trauma without obvious injury to other organs. J Cardiothorac Surg. 2013;8(1):2–5. doi: 10.1186/1749-8090-8-205. - DOI - PMC - PubMed
    1. Ahn HJ, Lee JW, Kim KD, You IS. Phrenic arterial injury presenting as delayed hemothorax complicating simple rib fracture. J Korean Med Sci. 2016;31(4):641–643. doi: 10.3346/jkms.2016.31.4.641. - DOI - PMC - PubMed
    1. Aoki M, Shibuya K, Kaneko M, et al. Massive hemothorax due to inferior phrenic artery injury after blunt trauma. World J Emerg Surg. 2015;10(1):58. doi: 10.1186/s13017-015-0052-3.. - DOI - PMC - PubMed
    1. Ota H, Kawai H, Matsuo T. Video-assisted minithoracotomy for blunt diaphragmatic rupture presenting as a delayed hemothorax. Ann Thorac Cardiovasc Surg. 2014;20:911–914. doi: 10.5761/atcs.cr.13-00201. - DOI - PubMed
    1. Chemelli AP, Thauerer M, Wiedermann F, Strasak A, Klocker J, Chemelli-Steingruber IE. Transcatheter arterial embolization for the management of iatrogenic and blunt traumatic intercostal artery injuries. J Vasc Surg. 2009;49(6):1505–1513. doi: 10.1016/j.jvs.2009.02.001. - DOI - PubMed

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