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What is an Extrapleural Hematoma?

Severe Rib Fracture

An extrapleural hematoma is a severe complication that can develop following a blunt chest injury that leads to a rib fracture. Individuals can sustain a direct chest injury in a variety of ways. One of the most common is in a motorcycle accident or a car accident, where someone strikes the steering wheel or dashboard. Blunt chest injuries can also be seen in physical assaults or certain contact sports. Major impacts from blunt chest injuries can lead to a rib fracture, which might cause an extrapleural hematoma.

An extrapleural hematoma following a rib fracture requires emergency medical care. If not treated quickly, this complication may even be life-threatening. For this reason, there is some necessary information regarding this type of hematoma that everyone should know.

How Does an Extrapleural Hematoma Occur?

When someone suffers a blunt injury to the chest, it may result in a rib fracture. One or more fragments of this rib can puncture essential blood vessels that flow through the chest. This can cause internal bleeding, which might lead to the buildup of blood in specific locations throughout the chest cavity.

Sometimes, blood can build up between the lining of the lung and the protective lining of the chest, called fascia. This buildup results when vital blood vessels, called intercostal vessels, are ruptured. When this happens, blood will slowly leak out and build up in the extrapleural space. This buildup of blood is called a hematoma.

There are a few critical symptoms that doctors will look for following a blunt injury to the chest. First, significant bruising on the chest may indicate an underlying rib fracture. If an underlying extrapleural hematoma is present, this pocket of blood will accumulate gradually. As the pocket enlarges, the patient may start to have trouble breathing. The patient’s blood pressure may also begin to drop. These are potentially life-threatening symptoms that merit emergency diagnosis and treatment.

Confirming the Diagnosis

Even though the physician may suspect this injury immediately, it is essential to identify precisely which blood vessel is causing the hematoma. This is crucial in planning the treatment approach. The most appropriate method to diagnose an extrapleural hematoma is called a contrast-enhanced CT.

A CT is fast, relatively inexpensive, and can accurately identify the bleeding vessel with the help of contrast. Medical contrast can be injected through an IV line and will travel throughout the body. With the help of a CT scan, the doctor should be able to see this contrast go through the bleeding vessel and into the chest cavity. Identifying this blood vessel will help the physician decide on the most appropriate treatment.

Treatment Options

The doctor will discuss a variety of treatment options with the patient. It is crucial to keep in mind that this is considered a medical emergency and must be treated quickly. The doctor may offer a treatment option called transcatheter arterial embolization. This treatment involves snaking a wire through the vascular system to the target blood vessel. Then, the vessel will be clotted off. This treatment can help a patient avoid thoracic surgery; however, it is not as effective.

More than likely, this injury is going to require surgery. A trained thoracic surgeon will open up the rib cage, find the bleeding vessel, and stop the hemorrhage directly. The hematoma will also be drained. An extrapleural hematoma is considered to be life-threatening; however, with rapid diagnosis and treatment, patients can make a meaningful recovery. The rib fracture will take about six weeks to heal. If surgery is required, the recovery process will take a few months.

Watch YouTube Video: Rib Fracture Stabilization: An Old Idea Made New. In the following video, Dr. Brian Kim with the Mayo Clinic Department of Trauma discusses using advanced technology to stabilize rib fractures.

Sacramento Motorcycle Accident Attorney

I’m Ed Smith, a Sacramento Motorcycle Accident Attorney. An extrapleural hematoma represents a severe and potentially life-threatening complication that may follow a rib injury. If one of your loved ones has suffered a significant injury following a motorcycle collision due to the negligence of another person or entity, you can reach me by dialing (916) 921-6400 or toll-free at (800) 404-5400.

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