IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Traumatic Extrapleural Haematoma Imitating Pericardial and Pleural Pathology
Mohammed Wesam Khalil, FRCS,
Rajwinder S. Jutley, FRCS,
David A. Waller, FRCS,
Leonidas Hadjinikolaou, FRCS
Department of Cardiothoracic Surgery, Glenfield Hospital, Groby Road, Leicester, UK
Mr Mohammed Wesam Khalil, Tel: +44 7733471051, Fax: +44 116 2563139, Email: wesam{at}doctor.com, Department of Cardiothoracic surgery, Glenfield Hospital, Groby Road, Leicester, United Kingdom.
A 23-year-old male presented to our unit after being stamped on his right hemithorax just lateral to the sternum. A chest X-ray (Figure 1
) revealed a white out on the right side. Over 3 litres of blood were drained on thoracocentesis. CT scan demonstrated a right-sided haematoma extending across the midline to the left cardiac border (Figure 2). Note translucent halo around the heart, suggesting intact pericardium. This should suggest extrapleural bleed with intact pleura, since the mediastinal and parietal pleura normally do not extend to the opposite side across the sternum. Again, the haematoma was apical and anterior. An intrapleural haematoma would be more basal and posterior.
View larger version (93K):
[in this window]
[in a new window]
|
Figure 1. Chest X-ray showing an almost complete whiteout on the right side; the lower aspect of the right chest is spared, and the right costophrenic angle is sharp and distinct.
|
|
View larger version (133K):
[in this window]
[in a new window]
|
Figure 2. CT scan of the chest showing a large right-sided haematoma causing mediastinal shift and extending to the left side across the anterior aspect of the pericardium.
|
|
At thoracotomy, haemorrhage was identified from the internal thoracic vein, stripping the pleura all the way from the apex to the level of the fifth rib extending anteriorly. This was controlled by cauterization. Patient did well post-operatively.
Asian Cardiovasc Thorac Ann 2009;
17:327-328
© 2009 by SAGE Publications
DOI: 10.1177/0218492309105241
