Delayed, Life-threatening Hemothorax due to Laceration of Supradiaphragmatic Inferior Vena Cava in Association with Blunt Thoracic Trauma

Abstract

We present a case of delayed, massive, life threatening hemothorax due to laceration of the supradiaphragmaitic inferior vena cava in association with blunt thoracic trauma. A 51-year-old man was involved in a traffic accident. While riding his bicycle, he collided with a car. On arrival at our emergency department his vital signs were stable and chest x-rays revealed no abnormal findings. However, twenty-one hours later he complained of difficulty with breathing and suddenly went into shock. Emergency computed tomography revealed a massive right hemothorax without pneumothorax or rib fracture, and chest tube drainage was performed. Because of rapid blood loss from the drainage tube, we decided to perform an immediate open thoracotomy, during which we found that the supradiaphragmatic inferior vena cava was lacerated. Homeostasis was achieved with by suture ligation of the injured sites. The patient's postoperative course was uneventful. Laceration of the supradiaphragmatic inferior vena cava resulting from blunt trauma is relatively rare, but extremely serious. Several days of observation in hospital may be required for patients with severe blunt thoracic trauma.