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Wed Aug 24 16:48:59 BST 2005

Likely rib fractures, yes I would drain in some way. If it is clotted will require more than tube to drain.  RW 

-----Original Message-----
From: YoramKl at clalit.org.il
To: trauma-list at trauma.org
Sent: Wed, 24 Aug 2005 15:25:23 +0200
Subject: extra-pleural hematoma

A week ago we had a young woman, unrestrained passenger that was injured in an 
MVC. She was apneic on the scene, hypotensive, GCS=3 with fixed dilated pupils. 
She was intubated by the paramedic and was brought to our ED. She had a positive 
FAST, and a widened mediastinum in the CXR. She was taken to the OR where a 
splenectomy was done (less than a 500cc of blood in the abdomen). After the 
operation we took her to the CT scanner. She had severe brain edema with minimal 
SAH. In the angio-CT of the chest we found a large posterior extra-pleural 
hematoma (see sample images). Despite normally looking aorta we continued to a 
formal angiography. The aorta and its branches, including the intercostal 
arteries were intact. At this point the patient is coagulopathic a hemodynamic 
compromised. 

1. What can be the source of this hematoma?
2. Would you do a thoracotomy? 
Best regards

Yoram Klein 

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extra-pleural hematoma