Delayed-Onset Hemothorax Following Cough-Induced Rib Fracture

Abstract

Hemothorax, the accumulation of blood in the pleural space, is most frequently linked to chest trauma but can occasionally result from nontraumatic causes such as persistent or forceful coughing. Cough-induced rib fractures are rare, with an even less frequent association with hemothorax. We describe a case involving a 57-year-old male who presented with a worsening cough and left-sided pleuritic chest pain despite prior antibiotic and symptomatic treatment. Initial imaging revealed a minimally displaced 10th rib fracture, left-sided atelectasis, and trace pleural effusion. During his hospital stay, he developed acute respiratory distress and increased chest pain, with repeat imaging revealing a large left-sided hemothorax. Chest tube placement drained 1100 mL of blood, supporting the diagnosis of hemothorax, as evidenced by clinical presentation and imaging, despite the absence of fluid analysis. The patient's condition improved following the intervention, and he was discharged in stable condition without recurrence of hemothorax on follow-up imaging. This case highlights the rare association between cough-induced traumatic rib fractures and delayed development of hemothorax. While rib fractures typically result from blunt trauma, they can also occur from stress or repetitive coughing. Complications such as hemothorax are uncommon but potentially life-threatening. The interval development of hemothorax, as seen in this patient, underscores the importance of serial monitoring in cases of rib fractures with ongoing symptoms. Clinicians should maintain a high index of suspicion for hemothorax in patients presenting with rib fractures and persistent cough, particularly in the context of worsening respiratory symptoms or pleuritic chest pain. Early recognition and timely intervention are critical to optimizing outcomes and mitigating the risks of rapid clinical deterioration.

Figure 1

Computed tomography (CT) of the chest coronal view on admission shows minimally displaced transverse fracture of the 10^th rib (red arrow).

Figure 2

CT of the chest axial view done on Day 5 shows a large left pleural effusion (red arrow) with no contusion observed.