title: A patient with refractory shock induced by several factors, including obstruction because of a posterior mediastinal hematoma.
abstract: A 44-year-old man who drove a motorcycle experienced a collision with the side of another motorcycle. Because he had sustained a high-energy injury to the spinal cord, he was transferred to our hospital. His circulation was unstable, and received tracheal intubation in addition to thoracostomy for the hemothorax. Whole-body computed tomography (CT) revealed multiple fractures, right hemopneumothorax with pulmonary contusion, and minor liver injury. After infusing 5000 mL of lactated Ringer's solution and 10 units of blood, his circulation remained unstable. On a repeat CT examination, the left atrium was found to be compressed by a posterior mediastinal hematoma induced by the fracture of the thoracic spine, and a diagnosis of shock induced by multiple factors, including hemorrhagic, neurogenic, and obstructive mechanisms, was made. After obtaining stable circulation and respirations, internal fixation of the extremities and extubation were performed on the 12th hospital day. Chest CT performed on the 27th day showed the disappearance of compression of the left atrium by the hematoma.
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
authors.forename: Mariko
authors.initials: M
authors.lastname: Obinata
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
authors.forename: Kouhei
authors.initials: K
authors.lastname: Ishikawa
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Osaka
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mishima
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Omori
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University.
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Oode
authors.affiliation: Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University. Electronic address: yyanaga@juntendo.ac.jp.
authors.forename: Youichi
authors.initials: Y
authors.lastname: Yanagawa
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000601:surgery; D012307:Risk Factors; D012769:Shock / Q000209:etiology*; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed