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      Delayed chest wall hematoma caused by progressive displacement of rib fractures after blunt trauma

      case-report

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          Abstract

          Rib fracture is a common injury resulting from blunt thoracic trauma. Although hemothorax and pneumothorax are known delayed complications of rib fracture, delayed chest wall hematoma has rarely been reported. We discuss the case of an 81-year-old woman who was not undergoing antiplatelet or anticoagulant therapy who presented to our emergency department after a traffic injury. This patient had a nondisplaced rib fracture that went undetected on the initial computed tomography scan; the development of progressive displacement led to hemorrhagic shock due to delayed chest wall hematoma. The chest wall hematoma was effectively diagnosed and treated via contrast-enhanced computed tomography and angiographic embolization. This case highlights the possibility of this potential delayed complication from a common injury such as a rib fracture.

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          Most cited references10

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          Blunt thoracic trauma. Analysis of 515 patients.

          A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. Severe chest trauma can be present in the absence of rib or other thoracic bony fractures. Emergency thoracotomies for resuscitation of the patient with blunt chest trauma with absent vital signs proved unsuccessful in 39 of 39 patients. A high index of suspicion for blunt chest injury occurring in blunt trauma, coupled with an aggressive diagnostic and therapeutic approach, remains the cornerstone of treatment to minimize the morbidity and mortality of such injuries.
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            Embolization of acute nonvariceal upper gastrointestinal hemorrhage resistant to endoscopic treatment: results and predictors of recurrent bleeding.

            Acute nonvariceal upper gastrointestinal (UGI) hemorrhage is a frequent complication associated with significant morbidity and mortality. The most common cause of UGI bleeding is peptic ulcer disease, but the differential diagnosis is diverse and includes tumors; ischemia; gastritis; arteriovenous malformations, such as Dieulafoy lesions; Mallory-Weiss tears; trauma; and iatrogenic causes. Aggressive treatment with early endoscopic hemostasis is essential for a favorable outcome. However, severe bleeding despite conservative medical treatment or endoscopic intervention occurs in 5-10% of patients, requiring surgery or transcatheter arterial embolization. Surgical intervention is usually an expeditious and gratifying endeavor, but it can be associated with high operative mortality rates. Endovascular management using superselective catheterization of the culprit vessel, «sandwich» occlusion, or blind embolization has emerged as an alternative to emergent operative intervention for high-risk patients and is now considered the first-line therapy for massive UGI bleeding refractory to endoscopic treatment. Indeed, many published studies have confirmed the feasibility of this approach and its high technical and clinical success rates, which range from 69 to 100% and from 63 to 97%, respectively, even if the choice of the best embolic agent among coils, cyanaocrylate glue, gelatin sponge, or calibrated particles remains a matter of debate. However, factors influencing clinical outcome, especially predictors of early rebleeding, are poorly understood, and few studies have addressed this issue. This review of the literature will attempt to define the role of embolotherapy for acute nonvariceal UGI hemorrhage that fails to respond to endoscopic hemostasis and to summarize data on factors predicting angiographic and embolization failure.
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              Chest wall, lung, and pleural space trauma.

              L. Miller (2006)
              Chest radiographs frequently underestimate the severity and extent of chest trauma and, in some cases, fail to detect the presence of injury. CT is more sensitive than chest radiography in the detection of pulmonary, pleural, and osseous abnormalities in the patient who has chest trauma. With the advent of multidetector CT (MDCT), high-quality multiplanar reformations are obtained easily and add to the diagnostic capabilities of MDCT. This article reviews the radiographic and CT findings of chest wall, pleural, and pulmonary injuries that are seen in the patient who has experienced blunt thoracic trauma.
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                Author and article information

                Contributors
                Journal
                Trauma Case Rep
                Trauma Case Rep
                Trauma Case Reports
                Elsevier
                2352-6440
                14 June 2016
                June 2016
                14 June 2016
                : 4
                : 1-4
                Affiliations
                [a ]Department of Emergency and Critical Care Medicine, Niigata City General Hospital, 463-7, Shumoku, Chuo-ku, Niigata 950-1197, Japan
                [b ]Department of Emergency and Critical Care Medicine, Uonuma Kikan Hospital, 4132, Urasa, Minamiuonuma, Niigata 949-7302, Japan
                Author notes
                [* ]Corresponding author at: Department of Emergency and Critical Care Medicine, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, Japan. Tel.: + 81 25 281 5151; fax: + 81 25 281 5187. s_nobuhiro@ 123456hosp.niigata.niigata.jp
                Article
                S2352-6440(16)30005-X
                10.1016/j.tcr.2016.05.001
                6011857
                29942843
                ca9a5153-61a6-45b3-9594-849ffd22aafa
                © 2016 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 28 May 2016
                Categories
                Article

                angiography,chest wall,delayed complication,rib fracture,thoracic injury

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