Abstract
An 84-year-old man was monitored for an expanding mass shadow in the right thorax. His medical history included lung cancer, which had been treated by right upper lobectomy. Computed tomography (CT) revealed expansion of the mass shadow into the retroperitoneum. On the basis of findings of aspirates, we diagnosed the mass as a hematoma. Although the patient's symptoms resolved with conservative treatments transiently, symptoms and expansion of hematoma repeated. We removed the hematoma with the capsule, performed thoracoplasty, and filled the vacant thoracic space with the omentum and an intercostal muscle flap. The postoperative course was mostly favorable. Approximately 9 months later, a subcutaneous hematoma appeared near the surgical scar on the patient's back. We applied drainage and several OK-432 injections. After that, there was no recurrence of the hematoma. There are a few case reports describing chronic expanding hematoma (CEH) in the thorax progressing into extrapleural spaces. Especially, cases of CEH in the thorax progressing into the retroperitoneum are rare. In our case, the hematoma expanded into the retroperitoneum perforating the diaphragm and formed new lesions. A similar case has not been reported. In addition, the recurrence of hematoma was observed in spite of a small amount of capsule remnant, and was treated conservatively. In conclusion, we encountered a rare and interesting case of CEH in the thorax. This case will help to understand the mechanism of progression and recurrence of CEH, and decide on treatments.
