Abstract
Background
An extrapleural hematoma (EH) is an uncommon and potentially life-threatening condition
defined as the accumulation of blood in the extrapleural space between the parietal
pleura and the endothoracic fascia. EH usually occurs after blunt thoracic trauma
causing fractures of the sternum and ribs, which can tear the intercostal or internal
mammary vessels. Typical radiological findings of EH are a biconvex opacity on the
involved hemithorax and the so-called displaced “extrapleural fat sign.”
Case Report
We present a case of a 36-year-old man with an isolated scapular fracture after a
high-energy blunt chest trauma complicated with a large contralateral EH that was
successfully managed nonoperatively with transcatheter arterial embolization (TAE)
and image-guided drainage with a pig-tail catheter. To the best of our knowledge there
is only one previous report describing a large EH after blunt thoracic trauma without
rib fractures. Only two previous cases of large EHs have been treated initially with
TAE, but both patients ultimately required open surgery.
Why Should an Emergency Physician Be Aware of This?
Patients with EH can present with respiratory distress and hypotension, so early identification
is important to facilitate proper treatment. EH has characteristic radiological findings,
and contrast-enhanced computed tomography is not only the best imaging tool for confirming
an EH, but also the best technique for detecting the source of the bleeding and other
serious thoracic complications that may not be evident on chest x-ray studies.
Keywords
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Article info
Publication history
Published online: April 25, 2016
Accepted:
February 17,
2016
Received in revised form:
November 5,
2015
Received:
January 18,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
