Delayed Hemothorax Due to Thoracic Trauma with Multiple Rib Fracture: A Case Report

Authors

  • Amaro Yudho Wibowo Muhammadiyah Mardhatillah Hospital, Pemalang
  • Sofian Palupi Muhammadiyah Mardhatillah Hospital, Pemalang
  • Raden Sri Triyono Muhammadiyah Mardhatillah Hospital, Pemalang

DOI:

https://doi.org/10.46799/jhs.v5i6.1298

Keywords:

case report, delayed hemothorax, thoracic trauma

Abstract

Recent evidence indicates that elderly who have suffered rib fractures may develop delayed massive hemothorax. Delayed enormous hemothorax after thoracic trauma is uncommon, but it is nevertheless linked to high rates of mortality. This single case report provides an overview of the ordinary and important delayed hemothorax caused by thoracic trauma with multiple rib fractures in limited healthcare facilities. We observe symptoms and chest X-rays before and after the development of delayed hemothorax. A 56-year-old man came to the hospital with complaints of shortness of breath and pain in the chest and right shoulder. The patient said that four days ago, He fell from a height of around 6 meters. After visiting the hospital four days prior, the patient was diagnosed with multiple fractures of the inferior aspect of the right ribs (costa 3-7) as well as a fracture of the right clavicle. However, the patient declined surgery and was made to return home. At that time, the patient did not experience shortness of breath. Currently, the patient is experiencing dyspnea. Blood pressure 138/91 mmHg, heart rate 89 beats per minute, respiration rate 26 times per minute, Spo2 91% room air. The chest x-ray currently shows a right hemothorax. After stabilization, the patient asked to be referred to another hospital for further treatment. Patients with multiple fractured ribs, especially with rib displacement, are at high risk of evolving delayed hemothorax. Close monitoring and observation for several days are necessary.

References

Asim, M., El-Menyar, A., Chughtai, T., Al-Hassani, A., Abdelrahman, H., Rizoli, S., & Al-Thani, H. (2023). Shock Index for the Prediction of Interventions and Mortality in Patients With Blunt Thoracic Trauma. Journal of Surgical Research, 283, 438–448. https://doi.org/10.1016/j.jss.2022.10.067

Buyukkaya, A., & Buyukkaya, R. (2024). Delayed Presentation of Traumatic Diaphragmatic Rupture With Hemothorax. Archivos de Bronconeumologia, 60(5), 304–305. https://doi.org/10.1016/j.arbres.2024.02.006

Elbers, L. P. B., Fliers, E., & Cannegieter, S. C. (2018). The influence of thyroid function on the coagulation system and its clinical consequences. In Journal of Thrombosis and Haemostasis (Vol. 16, Issue 4). https://doi.org/10.1111/jth.13970

Fermin, P., & Henderson, L. (2022). Delayed traumatic hemothorax. Visual Journal of Emergency Medicine, 29. https://doi.org/10.1016/j.visj.2022.101544

Gilaed, A., Shorbaji, N., Katzir, O., Ankol, S., Badarni, K., Andrawus, E., Roimi, M., Katz, A., Bar-Lavie, Y., Raz, A., & Epstein, D. (2024). Early risk factors for prolonged mechanical ventilation in patients with severe blunt thoracic trauma: A retrospective cohort study. Injury, 55(1). https://doi.org/10.1016/j.injury.2023.111194

Gioffrè-Florio, M., Murabito, L. M., Visalli, C., Pergolizzi, F. P., & Famà, F. (2018). Trauma in elderly patients: A study of prevalence, comorbidities, and gender differences. Giornale Di Chirurgia, 39(1). https://doi.org/10.11138/gchir/2018.39.1.035

Hanabusa, Y., Kubo, T., Watadani, T., Nagano, M., Nakajima, J., & Abe, O. (2022). Successful transcatheter arterial embolization for a massive hemothorax caused by acupuncture. Radiology Case Reports, 17(9), 3107–3110. https://doi.org/10.1016/j.radcr.2022.05.040

Herrod, P. J., Boyd-Carson, H., Doleman, B., Blackwell, J., Williams, J. P., Bhalla, A., Nelson, R. L., Tou, S., & Lund, J. N. (2019). Prophylactic antibiotics for penetrating abdominal trauma: duration of use and antibiotic choice. In Cochrane Database of Systematic Reviews (Vol. 2019, Issue 12). https://doi.org/10.1002/14651858.CD010808.pub2

Lin, C.-H., Lu, C.-W., Lin, Y.-C., Ma, C.-Y., Kang, S.-C., Liao, C.-H., & Fu, C.-Y. (2024). Evaluation of the Cushion Effect in Blunt Abdominal Trauma Patients: A Computerized Analysis. Injury, 111677. https://doi.org/10.1016/J.INJURY.2024.111677

Löffler, M. T., Wu, P. hung, Pirmoazen, A. M., Joseph, G. B., Stewart, J. M., Saeed, I., Liu, J., Schafer, A. L., Schwartz, A. V., Link, T. M., & Kazakia, G. J. (2024). Microvascular disease not type 2 diabetes is associated with increased cortical porosity: A study of cortical bone microstructure and intracortical vessel characteristics. Bone Reports, 20. https://doi.org/10.1016/j.bonr.2024.101745

Muronoi, T., Kidani, A., Oka, K., Konishi, M., Kuramoto, S., Shimojo, Y., Hira, E., & Watanabe, H. (2020). Delayed massive hemothorax due to diaphragm injury with rib fracture: A case report. International Journal of Surgery Case Reports, 77, 133–137. https://doi.org/10.1016/j.ijscr.2020.10.125

Okamatsu, Y., Tsubouchi, K., Iwasaki, T., Nakamura, T., Nakashima, T., Nakatsuru, K., Takahata, Y., & Harada, T. (2022). Recurrent Massive Hemothorax of Unknown Etiology in an 85-Year-Old Man. Chest, 161(2), e103–e110. https://doi.org/10.1016/j.chest.2021.09.012

Ouwerkerk, J. J. J., Argandykov, D., Gerban, A., Proaño-Zamudio, J. A., Dorken-Gallastegi, A., Hwabejire, J. O., Kaafarani, H. M. A., Velmahos, G. C., & Parks, J. (2023). Delayed hemothorax readmissions after rib fracture in blunt trauma patients. Journal of Clinical Orthopaedics and Trauma, 45. https://doi.org/10.1016/j.jcot.2023.102259

Ozel, M., Tatliparmak, A. C., Cetinkaya, R., Sizlanan, A., Ak, R., & Yilmaz, S. (2024). Earthquake-related isolated blunt thoracic trauma patients: A special population study in the emergency department. American Journal of Emergency Medicine, 75, 148–153. https://doi.org/10.1016/j.ajem.2023.10.050

Rendeki, S., & Molnár, T. F. (2019). Pulmonary contusion. In Journal of Thoracic Disease (Vol. 11). https://doi.org/10.21037/jtd.2018.11.53

Talbot, B. S., Gange, C. P., Chaturvedi, A., Klionsky, N., Hobbs, S. K., & Chaturvedi, A. (2017). Traumatic rib injury: Patterns, imaging pitfalls, complications, and treatment. Radiographics, 37(2). https://doi.org/10.1148/rg.2017160100

Wang, B., & Peng, Z. (2024). The risk factors for delayed hemothorax in patients with rib fracture in the emergency department. American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2024.04.014

Wang, S., Yang, X., Ding, D., Wu, X., Han, Z., Sun, L. W., & Fan, Y. B. (2021). The changes of bone vessels and their role in bone loss in tail-suspended rats. Acta Astronautica, 189, 368–378. https://doi.org/10.1016/j.actaastro.2021.08.031

Xiao, C. L., Liu, L. L., Tang, W., Liu, W. Y., Wu, L. Y., & Zhao, K. (2024). Reduction of the trans-cortical vessel was associated with bone loss, another underlying mechanism of osteoporosis. Microvascular Research, 152. https://doi.org/10.1016/j.mvr.2023.104650

Yap, D., Ng, M., Chaudhury, M., & Mbakada, N. (2018). Longest delayed hemothorax reported after blunt chest injury. American Journal of Emergency Medicine, 36(1). https://doi.org/10.1016/j.ajem.2017.10.025

Downloads

Published

2024-06-24