Voluminous post-traumatic mediastinal haematoma: late presentation in DEA


Submitted: 17 February 2013
Accepted: 17 February 2013
Published: 18 October 2008
Abstract Views: 825
PDF: 1554
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Mediastinal haematoma in the settings of blunt chest trauma can produce potentially serious problems. Nonaortic sources include disruption of arch vessels, rupture of small mediastinal veins, fractures of ribs/sternum and injury to the intercostal and internal thoracic vessels. Rupture of the aorta and great vessels is less frequent. Mediastinal haematoma presents a dual threat to haemodynamic stability, both as source of blood loss and because of compression of vascular structures such as the heart and pulmonary arteries. The case presented here tells about a patient who was initially in good conditions and haemodynamically stable, with no radiologic abnormalities. Some hours later he developed chest pain with hypotension due to sudden growth of large mediastinal haematoma. Multiphase multi-detector CT (MDCT) in our case allowed prompt detection of active bleeding in the arterial phase, a specific sign of arterial injury, with cardiac tamponade, which required immediate surgical treatment. MDCT is commonly considered the gold standard in severe thoracic trauma. Improvements in CT scanner technology have markedly shortened scanning times and now provide cardiac and vessels images of high quality during routine chest CT examinations.

Luciano Cardinale, SCDU Radiologia, Ospedale San Luigi Gonzaga, Orbassano (TO)
Sandro Massimo Priola, SCDU Radiologia, Ospedale San Luigi Gonzaga, Orbassano (TO)
Antonio Prato, SCDU Radiologia, Ospedale San Luigi Gonzaga, Orbassano (TO)
Giovanni Volpicelli, SCDU Radiologia e Medicina d’Urgenza, Ospedale San Luigi Gonzaga, Orbassano (TO)
Cesare Fava, SCDU Radiologia, Ospedale San Luigi Gonzaga, Orbassano (TO)
Cardinale, L., Priola, S. M., Prato, A., Volpicelli, G., & Fava, C. (2008). Voluminous post-traumatic mediastinal haematoma: late presentation in DEA. Emergency Care Journal, 4(5), 34–37. https://doi.org/10.4081/ecj.2008.5.34

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