Report of a rare case: occult hemothorax due to blunt trauma without obvious injury to other organs

Journal of Cardiothoracic Surgery

Yukitoshi Satoh¹  Akira Iyoda²  Masahito Naito¹  Fumihiro Ogawa¹ 

[1] Department of Thoracic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan;Department of Thoracic Surgery, Toho University School of Medicine, Tokyo, Japan

关键词: Diaphragm rupture;    Inferior phrenic artery;    Trauma;    Hemothorax;   

Others  :  814853
DOI  :  10.1186/1749-8090-8-205

 received in 2013-07-25, accepted in 2013-10-28,  发布年份 2013

【 摘 要 】

Traumatic hemothorax commonly occurs accompanied by organ damage, such as rib fractures, lung injury and diaphragm rupture. Our reported patient was a 61-year-old man who fell down from a stepladder about 1 meter in height, resulting in a heavy blow to the left abdomen. He consulted a clinic because of left chest pain the next day and was transported to the emergency center of our hospital on diagnosis of hemothorax with hemorrhagic shock.

On computed tomography scanning with contrast medium, left hemothorax without rib fracture, diaphragm rupture or obvious organ injury was evident. We found only bleeding to the thoracic space from a branch of the left inferior phrenic artery without involvement of the abdomen. The patient underwent percutaneous angiography and embolization for hemostasis, and subsequently thoracotomy in order to check the active bleeding and remove the hematoma to improve respiratory. As thoracotomy findings, we found damage of a branch of the left inferior phrenic artery to the thoracic space without diaphragm rupture, and sutured the lesion. Such active intervention followed by surgical procedures was effective and should be considered for rare occurrences like the present case. We must consider not only traumatic diaphragm rupture, but also vascular damage by pressure trauma as etiological factors for hemothorax.

【 授权许可】

   
2013 Ogawa et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Mihos P, Potaris K, Gakidis J, Paraslevopoulos J, Varvatsoulis P, Gouqoutas B, et al.: Traumatic rupture of the diaphragm: experience with 65 patients. Injury 2003, 34:169-172.
• [2]Simpson DNL J, Shah AB, Rowlands BJ: Traumatic diaphragmatic rupture: associated injuries and outcome. Ann R Coll Surg Engl 2000, 82:4.
• [3]Shah R, Sabanathan S, Mearns AJ, Choudhury AK: Traumatic rupture of diaphragm. Ann Thorac Surg 1995, 60:1444-1449.
• [4]Meyers BFMC: Traumatic diaphragmatic hernia. Occult marker of serious injury. Ann Surg 1993, 218:8.
• [5]Pagliarello GCJ: Traumatic injury to the diaphragm: timely diagnosis and treatment. J Trauma 1992, 33:4.
• [6]Meads GECS, Pitt DF: Traumatic rupture of the right hemidiaphragm. J Trauma 1977, 17:5.
• [7]Mahmood I, Abdelrahman H, Al-Hassani A, Nabir S, Sebastian M, Maull K: Clinical management of occult hemothorax: a prospective study of 81 patients. Am J Surg 2011, 201:766-769.
• [8]Rupka AWC, Hallfeldt KK, Nast-Kolb D, Pfeifer KJ, Schweiberer L: Value of thoracic computed tomography in the first assessment of severely injured patients with blunt chest trauma: results of a prospective study. J Trauma 1997, 43:7.
• [9]Carrillo EHHB, Senler SO, Dykes JR, Maniscalco SP, Richardson JD: Embolization therapy as an alternative to thoracotomy in vascular injuries of the chest wall. Am Surg 1998, 64:7.
• [10]Chemelli AP, Thauerer M, Wiedermann F, Strasak A, Klocker J, Chemelli-Steingruber IE: Transcatheter arterial embolization for the management of iatrogenic and blunt traumatic intercostal artery injuries. J Trauma 2009, 49:1505-1513.