Electronic ISSN 2287-0237

VOLUME

UNRECOGNIZED HEMO-PNEUMOTHORAX FROM MAJOR CHEST INJURY LEADS TO FATAL CONDITION: A CASE REPORT

SEPTEMBER 2015 - VOL.10 | CASE REPORT

A case of major chest injury with multiple fractured ribs and unrecognized hemopneumothorax is presented. The patient, initially hit by a truck, was admitted for a few days with conservative treatment. A 2nd exanimation of the chest revealed hemothorax but no additional treatment was provided. Nine days after discharge, the patient returned to the hospital with persistent chest pain. Three weeks later, the patient developed high fever (38.2 °C). Blood examination showed leukocytosis with predominant polymorphonuclear cells. A chest tube was inserted into the right chest and the patient was transferred to a higher trauma center for an operation, which revealed 2,000 ml of clotted blood, and 500 ml of pus. Pus culture was positive for Staphylococcus aureus. Two weeks after the operation, the patient passed away with severe sepsis along with acute renal failure, liver failure, and disseminated intravascular coagulopathy (DIC). Unrecognized hemo-pneumothorax from major injury should be included in differential diagnosis. Insufficient care may lead to a fatal condition. Rural hospitals should be equipped with modern digitalized x-ray equipment for picture archiving and communication system (PACs) and telecommunication for consultation with specialists in tertiary hospitals.

Keywords

hemo-pneumothorax, major chest injury, thoracic CT scanning, digital radiography, subcutaneous emphysema, rural hospital

MEDIA
Figure 1: An upright chest film showing fracture of the right 6th-8th ribs with evidence of pneumothorax which presented as hypo-density area without lung marking at the apex of the right chest (arrow) and small areas of subcutaneous emphysema
(arrow head). The right side of the chest also showed hypodensity compared with the left side, but many lung markings were also presented.
Figure 2: An upright chest film showing fracture of the right 6th-8th ribs with evidence of pneumothorax and hemothorax (blunt costophrenic angle on the right side).
Figure 3: An upright chest film showing more hemothorax on the right chest with more displacement of rib fractures (6th-8th) compared with Figure 2.
Figure 4: An upright chest film showing massive right hemothorax with ICD in the right chest.
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