DELAYED MASSIVE HAEMOTHORAX COMPLICATING RIB FRACTURES: A RARE CASE PRESENTATION

Abstract

Introduction: Thoracic trauma is one of the major causes of mortality in road traffic accidents. The incidence of delayed haemothorax from blunt chest trauma ranges from 5.0-7.4%, with massive haemothorax being much rarer. Case report: We report a case of this uncommon situation involving a 65-year old gentleman with alleged motor-vehicle accident (MB vs. MB) and sustained multiple two parts of right 2^nd to 8^th rib fractures. He was hospitalized for five days for close monitoring and pain management. Unfortunately, two days after his discharged at 7 days post-MVA, he presented to us again with shortness of breath and right chest pain. He was tachycardic (PR: 130 bpm), mildly tachypnoeic (RR: 20 breaths/min) and his SpO₂ was 90% under room air. There was a marked reduced air entry all over his right lung area and was dull to percussion. Chest radiograph showed homogenous opacity all over the right lung. Right thoracostomy tube was inserted draining 800 mls of frank blood upon insertion and a total of 1250 mls within 12 hours. Packed cell was transfused and Tranexamic acid was given. Patient was given adequate analgesic therapy. The patient was later transferred to the nearest cardiothoracic centre for further management. Discussion & Conclusion: The possibility of delayed sequelae following chest trauma should be considered in blunt chest traumas and be communicated to the patient and the family to encourage vigilance and monitoring even after being discharged home from the initial hospital monitoring. Despite rarely requiring emergency surgery, delayed massive haemothorax is potentially life-threatening.