Rare case of massive Hemothorax caused by minor injury

A rare case of massive Hemothorax caused by a minor injury has appeared in the Journal of Medical Case Reports. Dr Koshi Ota at Department of Emergency Medicine, Osaka Medical College, Osaka, Japan and colleagues have reported the case.

The reported incidence of traumatic diaphragm injury (TDI) ranges from 0.8 to 8 %. A diagnosis of TDI is challenging as radiography and CT are insufficiently sensitive.

Massive hemothorax resulting from a minor injury mechanism is considered to be rare particularly when the diaphragm is injured along with intercostal artery.

Courtesy Journal of Medical Case Reports
An 83-year-old 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 haemorrhage 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.

Lessons learnt:-

• 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.