title: Nonoperative Management of a Large Extrapleural Hematoma after Blunt Chest Trauma.
abstract: BACKGROUND
  An extrapleural hematoma (EH) is an uncommon and potentially life-threatening condition defined as the accumulation of blood in the extrapleural space between the parietal pleura and the endothoracic fascia. EH usually occurs after blunt thoracic trauma causing fractures of the sternum and ribs, which can tear the intercostal or internal mammary vessels. Typical radiological findings of EH are a biconvex opacity on the involved hemithorax and the so-called displaced "extrapleural fat sign."
  
  
  METHODS
  We present a case of a 36-year-old man with an isolated scapular fracture after a high-energy blunt chest trauma complicated with a large contralateral EH that was successfully managed nonoperatively with transcatheter arterial embolization (TAE) and image-guided drainage with a pig-tail catheter. To the best of our knowledge there is only one previous report describing a large EH after blunt thoracic trauma without rib fractures. Only two previous cases of large EHs have been treated initially with TAE, but both patients ultimately required open surgery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Patients with EH can present with respiratory distress and hypotension, so early identification is important to facilitate proper treatment. EH has characteristic radiological findings, and contrast-enhanced computed tomography is not only the best imaging tool for confirming an EH, but also the best technique for detecting the source of the bleeding and other serious thoracic complications that may not be evident on chest x-ray studies.
authors.affiliation: Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Gorospe
authors.affiliation: Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Fernández-Méndez
authors.affiliation: Department of Radiology, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ayala-Carbonero
authors.affiliation: Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cabañero-Sánchez
authors.affiliation: Department of Thoracic Surgery, Ramón y Cajal University Hospital, Madrid, Spain.
authors.forename: Gemma María
authors.initials: GM
authors.lastname: Muñoz-Molina
mesh_terms: D000328:Adult; D017115:Catheter Ablation / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods*; D006406:Hematoma / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D013896:Thoracic Diseases / Q000209:etiology / Q000628:therapy*; D013898:Thoracic Injuries / Q000150:complications*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications*
keywords: CT; blunt chest trauma; extrapleural hematoma; nonoperative management