Angiographic embolization in chest wall hematoma due to handlebar injury—a rare case report

Abstract

We report a woman presenting with an expanding chest wall hematoma after handlebar injury. Computed tomography identified a right anterior-upper chest wall hematoma with extension to right shoulder and upper extremity. Moreover, an enhancing spot within the hematoma wasidentified,favoringapseudoaneurysm.Therightaxillaryarterial angiography revealed a pseudoaneurysm at the branch of right anterior humeral circumflex artery. Patient underwent angiographic embolization with subsequent surgical drainage and made a full recovery. Chest wall hematoma often results from trauma or iatrogenic procedures; it usually has a self-limiting course and can be managed conservatively [1–4]. However, a posttraumatic expanding chest wall hematoma due to active arterial bleeding is clinically infrequent and requires urgent surgical exploration with hemostasis. Managing such hematomas with angiographic embolization is rare in previous literature [1–4]. Herein, we report a patient with an expanding chest wall hematoma secondary to a handlebar injury (HBI) during cycling; and she was successfully treated by the hybrid method of angiographic embolization and subsequent surgical drainage. A 76-year-old woman presented to emergency services with an increasing mass over right anterior-upper chest wall immediately after falling onto the handlebar during bicycle riding. Her medical histories were remarkable only for coronary artery disease with aspirin consumption and uncontrollable diabetes mellitus. A painful, pulsating hematoma was found over upper-anterior chest wall with extension to right lower neck, axilla, and shoulder. Physical examination was noteworthy for tachycardia (110 beats per minute) and distended discoloration of right anterior-upper chestwall. The active range of motion over right shoulder was also limited because of this expanding anterior chest wall hematoma. The shoulder roentography did not show glenohumeral joint dislocation or proximal humerus fracture, but hemoglobin was reported as 6.2 g/dL. Computed tomography (CT) revealed a hypodense lesion over right upper chest wall on anterior aspect of right shoulder (Fig. 1A). In addition, an enhancing spot was seen within the hematoma, which indicated a pseudoaneurysm or active bleeder (Fig. 1B). Considering the critical scenario, we arranged for blood trans