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Case Reports
. 2020 Sep 11;28(1):92.
doi: 10.1186/s13049-020-00783-0.

Massive hemothorax due to bleeding from thoracic spinal fractures: a case series and systematic review

Kohei Ninomiya  1 , Akira Kuriyama  2 , Hayaki Uchino  1
Affiliations
Case Reports

Massive hemothorax due to bleeding from thoracic spinal fractures: a case series and systematic review

Kohei Ninomiya et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: Massive hemothorax secondary to thoracic spinal fractures is rare, and its clinical characteristics, treatment, and prognosis are unknown. We present two cases of thoracic spinal fracture-induced massive hemothorax and a systematic review of previously reported cases.

Methods: This study included patients with traumatic hemothorax from thoracic spinal fractures at a Japanese tertiary care hospital. A systematic review of published cases was undertaken through searches in PubMed, EMBASE, and ICHUSHI from inception to October 13, 2019.

Results: Case 1: An 81-year-old man developed hemodynamic instability from a right hemothorax with multiple rib fractures following a pedestrian-vehicle accident; > 1500 mL blood was evacuated through the intercostal drain. Thoracotomy showed hemorrhage from a T8-burst fracture, and gauze packing was used for hemostasis. Case 2: A 64-year-old man with right hemothorax and hypotension after a fall from height had hemorrhage from a T7-burst fracture, detected on thoracotomy, which was sealed with bone wax. Hypotension recurred during transfer; re-thoracotomy showed bleeding from a T7 fracture, which was packed with bone wax and gauze for hemostasis. The systematic review identified 10 similar cases and analyzed 12 cases, including the abovementioned cases. Inferior part of thoracic spines was prone to injury and induced right-sided hemothorax. Most patients developed hemodynamic instability, and some sustained intra-transfer hemorrhage; direct compression (gauze packing, bone wax, and hemostatic agents) was the commonest hemostatic procedure. The mortality rate was 33.3%.

Conclusions: Hemothorax due to thoracic spinal fracture can be fatal. Thoracotomy with direct compression is necessary in hemodynamically unstable patients.

Keywords: Hemothorax; Spinal fractures; Wounds and injuries.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Images from Case 1. a Chest radiography shows extended opacity of the right chest, and b computed tomography shows a T8-burst fracture (arrow head)
Fig. 2
Fig. 2
Images from Case 2: a Chest radiography shows a diffuse opacity of the right chest, and b computed tomography shows a T7-burst fracture (arrow head) and L1 fracture
Fig. 3
Fig. 3
Study selection
Fig. 4
Fig. 4
Our proposed treatment algorithm for massive hemothorax due to bleeding from a fracture of the thoracic spine. Abbreviations; CECT, contrast-enhanced computed tomography; DCS, damage-control surgery; ICU, intensive care unit; IR, interventional radiology
See this image and copyright information in PMC

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