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.