Large traumatic hemothorax

Case contributed by Andrew Dixon
Diagnosis certain

Presentation

Motor car versus a pole at high speed.

Patient Data

Age: 30
Gender: Male

Trauma Series

x-ray

Note the generalized increased density to the right hemithorax and well-defined homogenous density laterally with a well-defined margin representing a supine distribution fluid meniscus. There is midline shift to the left due to mass effect in the right hemithorax. Multiple bilateral rib fractures are seen including fractures posteriorly and laterally on the right which may indicate a flail segment. Nasogastric tube and ETT are appropriately positioned. Attempted pneumocath insertion on the left has been unsuccessful with the catheter within the axilla soft-tissues. Bilateral apical capping is likely related to combination of extra-pleural hematoma from rib fractures and the hemothorax itself on the right. Pulmonary vascular markings are poorly seen on the right indicating pulmonary contusion. Lower volume pulmonary contusion is seen on the left.      

Case Discussion

Typical appearance of a sizable right-sided traumatic hemothorax on supine chest x-ray.

Findings

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