Successful thoracoscopic evacuation of an extrapleural hematoma with delayed symptomatic pleural effusion: a case report

Masanori Shimomura,Masashi Iwasaki,Masayoshi Inoue,Shunta Ishihara

doi:10.1186/s40792-019-0691-9

Masanori Shimomura, Masashi Iwasaki + Show 2 more

Open Access

https://doi.org/10.1186/s40792-019-0691-9

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Abstract

BackgroundTraumatic extrapleural hematoma is a rare condition and is usually managed conservatively until spontaneous resolution unless active bleeding or expansion is found.Case presentationAn 80-year-old man taking an anticoagulant medication was referred to our hospital after accidentally falling in a street ditch while riding a bike. Chest X-ray and computed tomography (CT) scan showed multiple fractures on ribs 7–9, hemothorax, and extrapleural hematoma in the posterior chest wall. Though the patient’s hemothorax was improved by chest tube drainage, the extrapleural hematoma still remained. He was transferred to another hospital for rehabilitation, but he was readmitted to our hospital because of dyspnea with accumulation of left pleural effusion, including a subpopulation of neutrophils, but without bacterial infection. We performed thoracoscopic evacuation of the hematoma on day 57 after the initial blunt chest trauma. The patient has had no recurrence of pleuritis for 6 months after surgery.ConclusionSince posttraumatic extrapleural hematoma may result in delayed secondary intractable pleural effusion causing dyspnea, careful observation is necessary when considering indications of surgical intervention.

Highlights

Traumatic extrapleural hematoma is a rare condition and is usually managed conservatively until spontaneous resolution unless active bleeding or expansion is found.Case presentation: An 80-year-old man taking an anticoagulant medication was referred to our hospital after accidentally falling in a street ditch while riding a bike
Since posttraumatic extrapleural hematoma may result in delayed secondary intractable pleural effusion causing dyspnea, careful observation is necessary when considering indications of surgical intervention
We present the case of a patient with multiple rib fractures and an extrapleural hematoma requiring surgical treatment due to a delayed intractable pleural effusion during the chronic phase

Summary

Introduction

Traumatic extrapleural hematoma is a rare condition and is usually managed conservatively until spontaneous resolution unless active bleeding or expansion is found.Case presentation: An 80-year-old man taking an anticoagulant medication was referred to our hospital after accidentally falling in a street ditch while riding a bike. Conclusion: Since posttraumatic extrapleural hematoma may result in delayed secondary intractable pleural effusion causing dyspnea, careful observation is necessary when considering indications of surgical intervention. Patients with extrapleural hematomas should be treated surgically if their vital signs are unstable or if they are in hypovolemic shock.

Results

Conclusion