Abstract
A 64-year-old man visited a neighboring hospital with the chief complaint of left back pain, upon which chest X-ray images and a chest CT scan revealed fluid accumulation due to left pleural effusion. The patient was thus referred to our department under a suspicion of empyema. Empyema was also suspected on chest CT findings at our hospital, leading to the initiation of continuous drainage by placing a chest tube. The pleural effusion was pale-bloody but not purulent, with a shadow remaining in the upper left mid-lung area even after the drainage. With mild inflammatory reactions revealed upon blood exams, thoracoscopic surgery was carried out for the purpose of diagnostic treatment taking the possibility of diseases other than empyema, such as hematomas and tumors, into account. The thoracic findings revealed no hematoma inside the chest but a bulge of approximately 14 cm in diameter along the parietal pleura. A clot filling the parietal pleura was observed upon incision and it was diagnosed as a chest wall hematoma. The parietal pleura of the bulging part was resected and the clot was curetted ; however, no obvious bleeding point was confirmed. Recurrent bleeding was not observed from the chest walls and the patient was discharged from our hospital on Day 14 following the surgery. Approximately two years have passed since the surgery and no recurrent bleeding has been observed. The patient had no precritical histories of receiving surgeries, injuries and administration of anticoagulation agent, indicating that he had no predisposing factors for bleeding tendency. We report an rare case of acute spontaneous chest wall hematoma forming a mass in the thorax.
