Huge Extrapleural Hematoma Initially Diagnosed as Massive Hemothorax

Abstract

We report a 50-year-old man who presented with left chest pain after blunt thoracic trauma. A chest radiograph showed a fracture of the left 4th rib. Three days later, worsening chest pain and shortness of breath occurred. A repeated chest X-ray showed a complete opacity of the left hemithorax. The patient was reported to have a massive left hemothorax leading to a shift of the mediastinum to the right. Tube thoracostomy was performed immediately. However, only a small amount of blood-like fluid was drained and the left hemithorax still appeared as a near total opacity on the follow-up chest radiograph. These findings were interpreted as a massive clotted hemothorax. Surprisingly, an emergency video-assisted thoracic surgery (VATS) revealed no traumatic pleural collections but a huge pleural mass containing a large amount of dark, reddish blood clots. The blood clots were evacuated. No bleeding source was found. The patient made a good recovery and was discharged on the 3rd postoperative day.




J Med Cases. 2013;4(4):247-249
doi: https://doi.org/10.4021/jmc1071w