J Korean Med Sci.  2016 Apr;31(4):641-643. 10.3346/jkms.2016.31.4.641.

Phrenic Arterial Injury Presenting as Delayed Hemothorax Complicating Simple Rib Fracture

• Ahn HJ
• Lee JW
• Kim KD
• You IS

• KMID: 2363707
• DOI: http://doi.org/10.3346/jkms.2016.31.4.641

Abstract

Delayed hemothorax after blunt torso injury is rare, but might be associated with significant morbidity and mortality. We present a case of delayed hemothorax bleeding from phrenic artery injury in a 24-year-old woman. The patient suffered from multiple rib fractures on the right side, a right hemopneumothorax, thoracic vertebral injury and a pelvic bone fracture after a fall from a fourth floor window. Delayed hemothorax associated with phrenic artery bleeding, caused by a stab injury from a fractured rib segment, was treated successfully by a minimally invasive thoracoscopic surgery. Here, we have shown that fracture of a lower rib or ribs might be accompanied by delayed massive hemothorax that can be rapidly identified and promptly managed by thoracoscopic means.

Keyword

Thoracic Trauma; Hemothorax; Diaphragmatic Injury; Thoracic Surgery, Video-Assisted

MeSH Terms

Accidental Falls
Female
Hemothorax/*complications/surgery
Humans
Rib Fractures/complications/*diagnosis
Thoracic Arteries/diagnostic imaging
Time Factors
Young Adult

Figure

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  Fig. 1 Three dimensional reconstructed computed tomography showing right lower rib fractures (arrow) and compression fracture of thoracic vertebrae.

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  Fig. 2 Chest X-ray on 13th postoperative day, showing right-sided hemothorax with chest tube placement.

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  Fig. 3 Thoracoscopic view of the lesion. (A) Active arterial bleeding of a phrenic artery. (B) Site of hemostasis, noting the proximity between fractured rib end (arrow) and bleeding site.

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