Presentation
Motor vehicle accident
Patient Data
A massive amount of high-density fluid (25-44HU) is seen in the right pleural cavity, consistent with intrathoracic hemorrhage associated with ipsilateral near total lung collapse (apart from the anterior segment of the upper lobe), displacement of the trachea, mediastinum, and heart to the left side as well as depression of the right hemidiaphragm.
An ill-defined hyperattenuating component (54 HU in density) likely representing acute clotted hemorrhage (sentinel clot sign) is also seen within the posterior basal aspect of the right pleural cavity associated with displaced fracture of the adjacent 10th posterior rib (with gapping about 6 mm).
Another fracture is seen affecting the right 4th posteior rib with minimal displacement & no gapping.
Follow-up CT, 2 months after the evacuation of the right hemothorax, shows complete resolution of the massive hemothorax, re-expansion of the right lung with relative decreased volume of the lower lobe and residual linear atelectatic bands mainly at the middle and lower lung lobes.
Case Discussion
CT findings are impressive of tension hemothorax due to rib fracture with a sentinel hematoma likely indicating the anatomic site of bleeding. The patient had a full recovery.
Tension hemothorax is a rare but life-threatening condition.
CT helps in the diagnosis and localization of the bleeding site.