Haemothorax and incidental lymphoma in a multitrauma patient

Case contributed by Dr Dayu Gai

Presentation

This patient was brought in by ambulance after being involved in a motor vehicle accident. He had a CT trauma series performed which showed multiple traumatic findings.

Patient Data

Age: 85
Gender: Male
  1. There is a large retroperitoneal soft tissue density mass, (74 x 86 x 112 mm) extending from the level of the infrahepatic IVC to the bifurcation with associated para-aortic subcentimetre adenopathy, compatible with lymphoma. Associated prominent mediastinal adenopathy in the superior mediastinum, prevascular and subcarinal region.
  2. Large right haemothorax with associated basal atelectasis.
  3. Undisplaced fractures of the left anterolateral ribs seven and eight.

Case Discussion

In this case, the large retroperitoneal soft tissue mass was mistaken for a post traumatic haemorrhage initially. It is a good learning point to demonstrate the differential diagnoses of haemorrhage in a traumatic context. 

The features of this mass suggesting that it is solid versus liquid include:

  • well demarcated border
  • homogoenous hypodensity of the mass

This gentleman also has a traumatic haemothorax. Traumatic haemothorax is a common finding in both blunt and penetrating trauma. This is because chest trauma is found in up to 60% of trauma cases 1.
Chest tube insertion for drainage of the haemothorax is the mainstay of management. That being said, insertion of chest tubes has a high complication rate, with figures of 21-30% quoted in the literature 4. In patients who have excessive blood loss (1500 ml in 24 hours or 200 ml per hour for successive hours), surgical exploration is indicated 2. This can be with video-assisted thorascopic surgery (VATS) in haemodynamically stable patients, or thoracotomy in unstable patients.

After initial management, certain patients will have persistent thoracic clot loculation. If these clots are greater than 500 ml in volume or account for over 1/3 of the hemithoracic volume, surgical intervention is required, either VATS or thoracotomy 3

In this case, the coronal views show considerable homogenous hypoattenuating fluid in the right posterior hemithoracic region, with some active extravasation of hyperattenuating contrast via the pulmonary arteries.

Case contributed by A/Prof. Pramit Phal.

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Case Information

rID: 30636
Case created: 24th Aug 2014
Last edited: 8th Oct 2016
Systems: Chest, Haematology
Inclusion in quiz mode: Included

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