Successful management of traumatic giant pulmonary hematoma in poly-trauma patient

Abstract

Traumatic pulmonary giant hematoma, resulting from blunt trauma, is a relatively rare event. Here, we report the rare case of a patient with a giant traumatic pulmonary hematoma that was associated with blunt trauma. A 50-year-old man was admitted to our medical center after a fall from a height of 5 m. He was diagnosed with pulmonary contusion, and tests showed a huge pulmonary hematoma of approximately 8.2 × 5.3 × 13.2 cm in the left lung field along with other significant injuries. Treatment comprised of aggressive coagulation management, broad-spectrum antibiotics, and pulmonary hygiene. The patient's symptoms gradually improved and magnetic resonance scan revealed that he did not develop an abscess formation. No complications were seen at the 6 months follow-up visit. If the above mentioned measures would have failed to control the bleeding or secondary infection, then emergency surgery would have been warranted. Awareness of this kind of injury and efforts to reduce infection are important to guide the giant traumatic pulmonary hematoma to the benign course.

Keywords: Chest injury; Hematoma; Intensive care unit; Multiple trauma.

Fig. 1

Initial image work-up in the emergency room. (A) Chest X-ray showing left pulmonary congestion. (B) Computed tomography (CT) scan of the chest, showing pulmonary contusion and pulmonary huge hematoma about 8.2 × 5.3 × 13.2 cm in the left lung field (white arrow) and right pneumothorax (arrowhead)a. (C) Coronal view of chest CT scan showing a huge hematoma (white arrow). (D) Sagittal view of chest CT scan showing a huge hematoma about 13.2 cm.

Fig. 2

Examinations after 1 month. (A) Chest CT scan showing huge hematoma about 7.2 × 5.2× 12.8 cm (white arrow). (B) Coronal view of chest CT scan showing a huge hematoma (white arrow). (C) Ultrasound guided tubography showing bronchopleural fistula in the left lung. Hematoma (white arrowhead), bronchus (black arrowhead).

Fig. 3

Examinations after 2 month. (A) Chest magnetic resonance imaging (MRI) examination demonstrating the characteristic signal pattern of a hyper-intense lesion on T1-weighted images, compatible with hematoma (white arrow). (B) Sagittal view of chest MRI scan showing a huge hematoma about 8.8 cm.

Fig. 4

Examinations after follow-up. (A) Chest CT scan 2 month later showing pulmonary hematoma about 5.4 × 4.2 × 8.8 cm (white arrow). (B) Chest CT scan 4 month later showing pulmonary hematoma about 3.0 × 2.4 × 5.9 cm (white arrow). (C) Chest CT scan 6 month later showing pulmonary hematoma about 2.3 × 2.0 × 4.2 cm (white arrow).