Massive hemothorax due to bleeding from thoracic spinal fractures: a case series and systematic review
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ORIGINAL RESEARCH
Open Access
Massive hemothorax due to bleeding from thoracic spinal fractures: a case series and systematic review Kohei Ninomiya†, Akira Kuriyama*†
and Hayaki Uchino
Abstract Background: Massive hemothorax secondary to thoracic spinal fractures is rare, and its clinical characteristics, treatment, and prognosis are unknown. We present two cases of thoracic spinal fracture-induced massive hemothorax and a systematic review of previously reported cases. Methods: This study included patients with traumatic hemothorax from thoracic spinal fractures at a Japanese tertiary care hospital. A systematic review of published cases was undertaken through searches in PubMed, EMBASE, and ICHUSHI from inception to October 13, 2019. Results: Case 1: An 81-year-old man developed hemodynamic instability from a right hemothorax with multiple rib fractures following a pedestrian–vehicle accident; > 1500 mL blood was evacuated through the intercostal drain. Thoracotomy showed hemorrhage from a T8-burst fracture, and gauze packing was used for hemostasis. Case 2: A 64-year-old man with right hemothorax and hypotension after a fall from height had hemorrhage from a T7-burst fracture, detected on thoracotomy, which was sealed with bone wax. Hypotension recurred during transfer; rethoracotomy showed bleeding from a T7 fracture, which was packed with bone wax and gauze for hemostasis. The systematic review identified 10 similar cases and analyzed 12 cases, including the abovementioned cases. Inferior part of thoracic spines was prone to injury and induced right-sided hemothorax. Most patients developed hemodynamic instability, and some sustained intra-transfer hemorrhage; direct compression (gauze packing, bone wax, and hemostatic agents) was the commonest hemostatic procedure. The mortality rate was 33.3%. Conclusions: Hemothorax due to thoracic spinal fracture can be fatal. Thoracotomy with direct compression is necessary in hemodynamically unstable patients. Keywords: Wounds and injuries, Hemothorax, Spinal fractures
Background Chest injuries occur in approximately 60% of polytrauma patients and account for 20–25% of trauma-related mortality [1]. Two large observational studies from Level 1 trauma centers in the United States and China suggested hemothorax as a complication in 3.6 to 5.9% of all chest * Correspondence: [email protected]; [email protected] † Kohei Ninomiya and Akira Kuriyama contributed equally to this work. Emergency and Critical Care Center, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki, Okayama 710-8602, Japan
trauma, with associated mortality rates of 1.7–9.4% [2, 3]. Most cases of hemothorax can be usually managed by observation or tube thoracostomy alone. However, the available evidence suggests that chest trauma might be associated with poor prognosis. Hemothorax occurs from an injury to the pulmonary parenchyma, hilar vessels, heart (with a communicating defect between the pericardium and pleura), great vessels (opening into the pleura), intercostal vessels, or internal t
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